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目的探讨关节镜下膝关节后纵隔良性肿物切除方法及疗效。方法 2008年6月-2012年6月,收治膝关节后纵隔良性肿物患者12例。男8例,女4例;年龄22~50岁,平均36.5岁。病程3个月~2年,平均8.4个月。膝关节慢性滑膜炎症2例,腱鞘囊肿5例,腱鞘巨细胞瘤4例,滑膜血管瘤1例。10例为后纵隔单发肿物,2例肿物累及膝关节其他部位。患者均行关节镜下肿物切除术,常规作前内、前外侧入路,后内和/或后外侧入路,其中6例作跨后纵隔入路。结果患者术后切口均Ⅰ期愈合,无相关并发症发生。患者均获随访,随访时间12~46个月,平均18.5个月。患者膝关节疼痛明显缓解、膝关节屈曲明显改善。末次随访时,膝关节活动度由术前的(57.08±12.52)°增加至(120.83±13.95)°,疼痛视觉模拟评分(VAS)由术前的(5.00±1.04)分下降至(1.50±0.91)分,Lysholm评分由术前(49.50±9.07)分提高至(84.58±6.82)分,以上指标手术前后比较差异均有统计学意义(P<0.01)。结论采用关节镜技术能彻底切除累及膝关节后纵隔的肿物,且创伤小,能最大程度恢复膝关节功能。
Objective To study the method and effect of resection of posterior mediastinum in arthroscopy. Methods From June 2008 to June 2012, 12 patients with posterior mediastinal benign masses were treated. 8 males and 4 females; aged 22 to 50 years old, with an average of 36.5 years old. Duration of 3 months to 2 years, an average of 8.4 months. 2 cases of chronic synovitis of knee joint, 5 cases of ganglion cyst, 4 cases of tendon sheath giant cell tumor and 1 case of synovial hemangioma. 10 cases of posterior mediastinum single tumor, 2 cases involving other parts of the knee. Patients underwent arthroscopic resection of the tumor. Conventional anterior, anterolateral and posterior and / or posterolateral approaches were performed. Six of them underwent transseptal approach. Results All the incisions healed in stage I without any complications. Patients were followed up for 12 to 46 months (average 18.5 months). Patients with knee pain relief, knee flexion significantly improved. At final follow-up, the knee mobility increased from (57.08 ± 12.52) ° to (120.83 ± 13.95) ° and the VAS decreased from (5.00 ± 1.04) preoperatively to (1.50 ± 0.91) ) Points, the Lysholm score increased from (49.50 ± 9.07) points to (84.58 ± 6.82) points before and after operation, the above indexes had significant difference before and after operation (P <0.01). Conclusion The arthroscopic technique can completely remove the tumor involving the posterior mediastinum of the knee and has less trauma and can restore the function of the knee to the maximum extent.