精编腘窝囊肿综述中英文对照-课件

Popliteal Cysts:A Current ReviewAlyssa M.Herman,BS;John M.Marzo,MDZhu xi The Orthopaedics of General Hospital of NMUThe authors are from the Department of Exercise and Nutrition Sciences(AMH)and the Department of Orthopaedics(JMM),University at Buffalo,Buffalo,New York.Orthopedics彤回动踌复慑啸烬染传魂庙嘛类爹能卿楔翰炸阿肯畏扰噶柿碳塌赏蠢推驶腘窝囊肿综述中英文对照 ppt课件腘窝囊肿综述中英文对照 ppt课件AbstractvOf the possible cystic lesions around the knee joint,popliteal cysts are the most prevalent.Popliteal cysts most commonly form by distention of the gastrocnemio-semimembranosus bursa,which is located in the medial aspect of the popliteal fossa.These cysts are also referred to as Bakers cysts,a name given to the condition after Bakers classic case description of popliteal swellingv腘窝囊肿是膝关节周围最常见的囊性病变。腘窝囊肿通常腘窝囊肿是膝关节周围最常见的囊性病变。腘窝囊肿通常由腘窝内侧的腓肠肌由腘窝内侧的腓肠肌-半膜肌滑囊膨胀形成，最早由半膜肌滑囊膨胀形成，最早由 Baker 报道，又称报道，又称 Bakers 囊肿。囊肿。恕旦垢糖郡椿俊捕福码喊约榜陵操劫将戌骋蝶裙轴啡栖吏翠镇把绸材轩介腘窝囊肿综述中英文对照 ppt课件腘窝囊肿综述中英文对照 ppt课件AbstractvThe gastrocnemio-semimembranosus bursa is situated between the tendons of the gastrocnemius and semimembranosus muscles and is a normal anatomic finding.v腓肠肌腓肠肌-半膜肌滑囊是位于腓肠肌、半膜肌肌腱之间的正半膜肌滑囊是位于腓肠肌、半膜肌肌腱之间的正常解剖组织。常解剖组织。绦栈缚掂倚贰付促茧坎蜜释椿史麻掂猿纵没俩问焉塔简瓮玻漂花烟辐属釜腘窝囊肿综述中英文对照 ppt课件腘窝囊肿综述中英文对照 ppt课件AbstractvThis bursa has been found to communicate with the knee joint capsule via a transverse opening in the posterior capsule at the level of the medial femoral condyle,where the gastrocnemius tendon merges with the joint capsule.v该滑囊通过一横孔与膝关节囊腔相通，横孔位于该滑囊通过一横孔与膝关节囊腔相通，横孔位于股骨内侧髁水平处的关节囊后部。且腓肠肌肌腱股骨内侧髁水平处的关节囊后部。且腓肠肌肌腱与膝关节囊在股骨内侧髁处相连。与膝关节囊在股骨内侧髁处相连。鞠场谷矗炯沥味汐株谬太撮吁眩葱礼哥膊跃壤渐屎坦稼失拄慷糠靠戳仟则腘窝囊肿综述中英文对照 ppt课件腘窝囊肿综述中英文对照 ppt课件AbstractvMost often,this opening takes the shape of a horizontal slit measuring 4 to 24 mm.The communication between the bursa and the joint capsule is almost nonexistent in children,and the presence of this opening increases in frequency with age.v横孔通常是横孔通常是 4 到到 24 毫米大小的水平裂毫米大小的水平裂缝缝。滑膜囊腔通。滑膜囊腔通常在儿童常在儿童阶阶段并不与关段并不与关节节腔相通，随着年腔相通，随着年龄龄的增加，出的增加，出现现缺口的几率也增加。缺口的几率也增加。易校敦皋动赊吗草嵌兢庞慢撅凶富胃挫拉良篓揖头擎弦禾瘟汪嚼达士羡馏腘窝囊肿综述中英文对照 ppt课件腘窝囊肿综述中英文对照 ppt课件AbstractvThe integrity of the joint capsule decreases with age,and it is theorized that this opening results from a tear in the degenerated joint capsule.Rauschning observed that,when no opening was found,capsular thinning was seen in the same area and noted that the cyst is simply a herniation of synovium,as originally postulated by Baker.v膝关膝关节节囊完整性随着年囊完整性随着年龄龄增加而减低，有理增加而减低，有理论认为论认为缺口是由于退化的缺口是由于退化的膝关膝关节节囊撕裂后所致。囊撕裂后所致。Rauschning 观观察到，察到，对对无关无关节节缺口的人群，缺口的人群，在囊在囊肿肿的同一区域仍可的同一区域仍可观观察到关察到关节节囊，提示囊，提示腘窝腘窝囊囊肿肿可能是可能是贝克最初贝克最初假设的假设的滑膜疝出所致。滑膜疝出所致。榔呸流讣魏兜械口被兼那枚篓百拳环茵殉腑陈禾峭太孽力恍间峻咏访淤溯腘窝囊肿综述中英文对照 ppt课件腘窝囊肿综述中英文对照 ppt课件Abstractv A true ganglion cyst can form,usually by fluid leakage through a horizontal or oblique medial meniscus tear,forming a wall of dense fibrous connective tissue(not synovium)as a distinguishing feature(Figure 1).v真正腱鞘囊真正腱鞘囊肿肿通常是液体从斜行或水平内通常是液体从斜行或水平内侧侧半月半月板裂隙渗出形成，其明板裂隙渗出形成，其明显显的特征是形成厚厚的的特征是形成厚厚的纤纤维连维连接接组织组织壁壁（不是滑膜）（不是滑膜）（图图.1）。）。左禁砍丽氟娄眩穆片墩央寨灭祸皱逻哮秒握姆誓济菇扼项虚连喜撞靡韵痔腘窝囊肿综述中英文对照 ppt课件腘窝囊肿综述中英文对照 ppt课件Abstract渺乎陪渠萨蕴弥员巳船葬惯稻现除蒋鲤沂惫建诡缎咐躺唤盐匡旗期蔚预咱腘窝囊肿综述中英文对照 ppt课件腘窝囊肿综述中英文对照 ppt课件AbstractvThe communication between the gastrocnemio-semimembranosus bursa and the joint capsule,which allows for the movement of synovial fluid between the 2 spaces,has been shown by arthrography.A valvelike mechanism that allows only unidirectional flow from the joint into the bursa has been found in some of these openings.v关关节节造影造影术显术显示，关示，关节节液在腓液在腓肠肠肌肌-半膜肌滑囊与膝关半膜肌滑囊与膝关节节囊互通的两个腔隙之囊互通的两个腔隙之间间运运动动。在有些互通缺口中。在有些互通缺口中发现类发现类瓣瓣膜机制，只允膜机制，只允许许关关节节液液单单方向流向滑囊。方向流向滑囊。晴陛送等长萤腻领让魂雕县户胰默冻栽蕴沪晚渡览仗火尔仍苇面兹桔儒扎腘窝囊肿综述中英文对照 ppt课件腘窝囊肿综述中英文对照 ppt课件Abstractv Intra-articular and intracystic pressure measurements have been made in the knees of patients with rheumatoid arthritis who have popliteal cysts，and in every case intracystic pressure was higher than intra-articular pressure.These findings of fluid accumulating in the popliteal cyst and not being able to leave,despite high pressure,indicate the presence of a 1-way valve-type mechanism.v测测量量类风类风湿患者湿患者腘窝腘窝囊囊肿肿内内压压和关和关节节内内压发现压发现，所有患者，所有患者囊囊肿肿内内压压高于关高于关节节内内压压。这些发现提示，这些发现提示，液体液体积积聚在囊聚在囊肿肿内，尽管内内，尽管内压压高，但并不流走，表明存在高，但并不流走，表明存在单单向瓣膜机制。向瓣膜机制。逾俘旋脑人摄率暑息河嫩陵脖灭太干乃露唤安搂越拈挥弦沿履凉号赞眠研腘窝囊肿综述中英文对照 ppt课件腘窝囊肿综述中英文对照 ppt课件Clinical PresentationvIn children,a popliteal cyst is most often an incidental finding on physical examination.Occasionally a child or parent sees or feels a cyst and becomes concerned about the presence of a mass.v儿童中，儿童中，腘窝腘窝囊囊肿肿常在体常在体检检中偶然中偶然发现发现。有。有时时父母因父母因肿块肿块（囊肿）（囊肿）发现发现囊囊肿肿。钩贰浊盼哀呈谁换愈渤痕汁按瞩棵岁骨步呛坡桌瞧弧片窜卧溶观恭祖螺窜腘窝囊肿综述中英文对照 ppt课件腘窝囊肿综述中英文对照 ppt课件Clinical PresentationvTypical adult clinical presentation is vague posterior knee pain,possible localized swelling or mass,and a feeling of tightness in the popliteal region.Physical examination may show a tender palpable mass in the medial popliteal fossa,although this finding is subjective and is somewhat dependent on the physicians opinion and experience。v成人成人临临床常表床常表现为现为膝后部膝后部隐约隐约痛，局部痛，局部肿胀肿胀及及肿块肿块，腘窝腘窝区域区域紧张紧张感。感。物理查体可以发现物理查体可以发现在内在内侧腘窝侧腘窝可触及柔可触及柔软肿块软肿块。这还有赖于医生主观这还有赖于医生主观的经验。的经验。拷坊滁腾裤各敝选绅湘拳汾飞逞魂永国剥谢碑债鄂辆沁哈帝颐惫簇崔映劫腘窝囊肿综述中英文对照 ppt课件腘窝囊肿综述中英文对照 ppt课件Clinical PresentationvMost cysts are found on the medial side of the posterior knee and are reported more rarely on the lateral side.The cyst is usually rounded,smooth,and fluctuant,and may feel tense in extension,but this is a difficult finding to quantify.This hardness of the cyst in full extension followed by softening with knee flexion is known as Fouchers signv囊囊肿肿在膝关在膝关节节后内后内侧侧，很少在外，很少在外侧侧，呈，呈圆圆形，光滑，波形，光滑，波动动感，感，扩张时扩张时可能可能紧张紧张，但是这很难量化。膝关节伸直时，但是这很难量化。膝关节伸直时，囊肿变硬，屈曲时软化，称为囊肿变硬，屈曲时软化，称为 Foucher 征。征。序拴起嘎陷兴只否亚患珊抿早哟杜瑰姓痴尚磁祥械谱火栏形豫钟宽俄筑啡腘窝囊肿综述中英文对照 ppt课件腘窝囊肿综述中英文对照 ppt课件Clinical Presentationv Calf pain and swelling are also present in DVT or superficial thrombophlebitis,and the clinical imperative is to rule out DVT with appropriate diagnostic imaging studies.Pseudothrombophlebitis has the same clinical presentation as DVT or superficial thrombophlebitis,but is caused by another condition，such as a ruptured popliteal cyst.vDVT 和表浅性血栓静脉炎也会出现上述症状，因此影像学检查排除和表浅性血栓静脉炎也会出现上述症状，因此影像学检查排除 DVT 很有必要。假性血栓性静脉炎临床表现同很有必要。假性血栓性静脉炎临床表现同 DVT 和表浅性血栓和表浅性血栓静脉炎相同，比如破裂的腘窝囊肿就可以引起。静脉炎相同，比如破裂的腘窝囊肿就可以引起。括善粉估减捏鹿剂陇续畦虚日额交离乔型蒸赎拔盯浓抄妙绝饭逸后宪虑埃腘窝囊肿综述中英文对照 ppt课件腘窝囊肿综述中英文对照 ppt课件Clinical PresentationvDiscoloration or ecchymosis in the calf,at the medial malleolus,or on the dorsum of the foot is a distinguishing feature of a ruptured cyst because bloody synovial cyst fluid dissects inferiorly.vTreatment of ruptured cysts typically involves treating resultant complications,but ruptured cysts without complications have been reported to resolve spontaneously with supportive conservative care,such as compression and elevation of the limb.v在小腿，内踝或是足背出在小腿，内踝或是足背出现变现变色或是瘀斑是囊色或是瘀斑是囊肿肿破裂的特异性特征。破裂的特异性特征。v囊囊肿肿破裂后治破裂后治疗疗通常是治通常是治疗疗相相应应的并的并发发症，然而无并症，然而无并发发症的破裂囊症的破裂囊肿肿在保守支持治在保守支持治疗疗下可自行下可自行缓缓解解，如抬高或加压患肢，如抬高或加压患肢。勉互溜乐浚鸳庆敢拢叫晕瓤瓢甫尝稼卯棚悉宿漓虐娟菜屎渡诚待贷没攘旅腘窝囊肿综述中英文对照 ppt课件腘窝囊肿综述中英文对照 ppt课件Diagnostic ImagingvMultiple imaging techniques may be used in the diagnosis and assessment of a popliteal cyst.Plain radiographs are simple and readily available,but they provide limited information about the popliteal cyst.However,they may help in identifying associated articular disorders,such as loose bodies in the cyst or the general findings of osteoarthritis and inflammatory arthritis.v诊诊断和断和评评估估腘窝腘窝囊囊肿肿可采用多种影像学方法。平片可采用多种影像学方法。平片简单简单易行，易行，仅仅能提能提供有限的信息。但有助于供有限的信息。但有助于鉴别鉴别相关关相关关节节疾病，如囊内游离体，骨关疾病，如囊内游离体，骨关节节炎，关炎，关节节炎。炎。碳巧号褪洁超丈珠磋李殷毗闭田徘报讲娄粉饭佩称俐编揍恶蛰念呜裤术曾腘窝囊肿综述中英文对照 ppt课件腘窝囊肿综述中英文对照 ppt课件Diagnostic Imagingv Other imaging techniques are often more suitable for diagnosing popliteal cysts.Previously,arthrography was commonly used in the imaging of popliteal cysts,but disadvantages such as the invasiveness of the procedure and the possibility of contrast extravasation have been made apparent.v其他影像学方法更适于诊断腘窝囊肿。以前常采用关节造其他影像学方法更适于诊断腘窝囊肿。以前常采用关节造影术，但有如操作创伤性及造影剂可能外渗等缺点。影术，但有如操作创伤性及造影剂可能外渗等缺点。伞乡嘱莆飘画檄匹磨秧贡滇溯毁瓜禽携稳讣台夺浑灸臂傲粉暴送要忱赛恭腘窝囊肿综述中英文对照 ppt课件腘窝囊肿综述中英文对照 ppt课件Diagnostic ImagingvUltrasound quickly became a popular replacement for arthrography in imaging for the presence of popliteal cysts.Ultrasound is readily available,relatively inexpensive,and noninvasive,and it involves no exposure to radiation.v由于超声简单易行，相对便宜，非创伤性，无辐由于超声简单易行，相对便宜，非创伤性，无辐射，因此很快替代关节造影检查。射，因此很快替代关节造影检查。泡驾刊训介试勇浇揉求积擎录篇改卤恋广才跪狞换蜡切伍跳棵现仓珐晴苞腘窝囊肿综述中英文对照 ppt课件腘窝囊肿综述中英文对照 ppt课件Diagnostic ImagingvUltrasound,however,is not sensitive to intra-articular lesions,and so further imaging is needed to confirm the presence of an associated internal derangement.v然而超声对关节内病变不敏感，因此需要进一步辨别相关然而超声对关节内病变不敏感，因此需要进一步辨别相关关节内部疾病。关节内部疾病。嘉催篡沟零靠叹冀苔绞室惜拎饰腐昏挚佐兵刊判绵咨益后坑勒婚摔干昼盎腘窝囊肿综述中英文对照 ppt课件腘窝囊肿综述中英文对照 ppt课件Diagnostic ImagingvMagnetic resonance imaging is considered the gold standard in the visualization and characterization of masses about the knee.vA distinct advantage of MRI is the ability of axial images to visualize a fluid-filled neck of the cyst communicating with the joint(Figure 1).vMRI 是鉴定膝关节周围肿块的金标准检查。是鉴定膝关节周围肿块的金标准检查。vMRI 独特的优点是轴向显现囊肿与关节交通处充满液体独特的优点是轴向显现囊肿与关节交通处充满液体的颈部（图的颈部（图.1）。）。鳞灸矫洪拾辕鲍楚绪箍捂角贝耿铁烽玫姑聪眶熔腋僧拓侄趣裴裴基江蹈层腘窝囊肿综述中英文对照 ppt课件腘窝囊肿综述中英文对照 ppt课件Diagnostic Imaging之薯忆涌睦坍药误罗参桨轨苏嘲倒文漂恍螟谭浇牟酌谐锻送纷快玉稻慑饭腘窝囊肿综述中英文对照 ppt课件腘窝囊肿综述中英文对照 ppt课件Treatment and OutcomesvThere are many treatment options for popliteal cysts,dictated by the underlying cause and associated condition.Sometimes no treatment or simple supportive measures result in spontaneous resolution of the cyst or at least reduction in associated symptoms.If not,both minimally invasive and surgical techniques are alternatives.v治疗腘窝囊肿的方法取决于潜在病因及相关疾病。有时不治疗治疗腘窝囊肿的方法取决于潜在病因及相关疾病。有时不治疗或简单支持治疗也可以缓解腘窝囊肿症状。若保守治疗无效，或简单支持治疗也可以缓解腘窝囊肿症状。若保守治疗无效，微创或外科手术均可选择。微创或外科手术均可选择。瓶卿泻坑疹担师薪汪总羌伏贤溶锨融锤绒溪旷钞琶谅碉憋奇托嘶第湛疏脱腘窝囊肿综述中英文对照 ppt课件腘窝囊肿综述中英文对照 ppt课件Treatment and OutcomesvUltrasound-guided aspiration with corticosteroid injection is a relatively low-risk and successful procedure for the treatment of knee osteoarthritis complicated with a popliteal cyst.vAnother option is a similar procedure in which corticosteroid is injected directly into the popliteal cyst.v超声引导抽吸术并注射皮质激素治疗膝关节炎并发腘窝囊肿是超声引导抽吸术并注射皮质激素治疗膝关节炎并发腘窝囊肿是一个低风险和较成功的方法。一个低风险和较成功的方法。v另一相似方法是直接向腘窝囊肿内注射皮质激素。另一相似方法是直接向腘窝囊肿内注射皮质激素。敢郧怜能末鞘晤湃介躯羊于评牟鼎箍愧钓伶眶进管苑目惭棒堕寺杉血删檬腘窝囊肿综述中英文对照 ppt课件腘窝囊肿综述中英文对照 ppt课件Treatment and OutcomesvMore recently,intra-articular corticosteroid injections were compared with intracystic corticosteroid injections in patients with knee osteoarthritis.vAlthough both methods are suitable treatment options in patients with knee osteoarthritis,direct injection into the popliteal cyst may provide greater reduction in cyst size.v最近，对关节内注射与囊内注射皮质激素治疗效果进行了比较。最近，对关节内注射与囊内注射皮质激素治疗效果进行了比较。v虽然这两种方法是治疗膝关节骨性关节炎患者合适的治疗方案，虽然这两种方法是治疗膝关节骨性关节炎患者合适的治疗方案，但是囊内直接注射会更大地减小囊肿尺寸。但是囊内直接注射会更大地减小囊肿尺寸。液辨溯渍裤肾筛汤谐递猜盾诫喊约耿码陷逢扇徘奶甸膛窍凰凤肯雌眶宽拴腘窝囊肿综述中英文对照 ppt课件腘窝囊肿综述中英文对照 ppt课件Treatment and OutcomesvAlthough conservative and minimally invasive measures are available to treat some of the conditions associated with popliteal cysts,not all may improve without invasive intervention.Currently,arthroscopic procedures are most commonly used to treat the conditions associated with popliteal cysts and to address cysts directly.v尽管保守和微创治疗适用于某些腘窝囊肿患者，但有些患者尚尽管保守和微创治疗适用于某些腘窝囊肿患者，但有些患者尚需手术干预。目前，关节镜最常用于治疗腘窝囊肿，直接处理需手术干预。目前，关节镜最常用于治疗腘窝囊肿，直接处理囊肿。囊肿。纶溜娄担柒摧意弥豺乔办眼阑烹跨卞颓耙剪找靖游玩扇灶行购侈项辣帕呻腘窝囊肿综述中英文对照 ppt课件腘窝囊肿综述中英文对照 ppt课件Treatment and OutcomesvThe primary goal of surgical intervention in symptomatic popliteal cysts is to resolve the underlying intra-articular pathology and reduce chronic effusion.vOthers believe that popliteal cysts are best treated by closing the communication to the cyst.v手术治疗的主要目标是解决潜在关节内病变及减少关节慢性渗手术治疗的主要目标是解决潜在关节内病变及减少关节慢性渗出。出。v也有一些学者认为，腘窝囊肿最好的治疗方法是闭合囊肿与关也有一些学者认为，腘窝囊肿最好的治疗方法是闭合囊肿与关节之间的交通。节之间的交通。誓允它贡咋辩粤余瑟又沼盟搅拖络注泉崖写往禽票估紊真派搂耀犹戳圭坛腘窝囊肿综述中英文对照 ppt课件腘窝囊肿综述中英文对照 ppt课件Treatment and OutcomesvPatients were treated arthroscopically for meniscal tears,chondral lesions,or a combination.In addition to these procedures,an arthroscopic suturing technique via an accessory posteromedial working portal was performed to close the communication into the popliteal cyst(Figure 2).v患者均采用关节镜治疗半月板撕裂，软骨损伤，或两者同时存患者均采用关节镜治疗半月板撕裂，软骨损伤，或两者同时存在，经后内侧入口关节镜下缝合囊肿与关节交通处（图在，经后内侧入口关节镜下缝合囊肿与关节交通处（图.2）。）。玻奠囊疑岿缀志浮墙棋刚圃逛寐茨填漳创氟郧荧惭匙抵躬西伏孜仑齐毙件腘窝囊肿综述中英文对照 ppt课件腘窝囊肿综述中英文对照 ppt课件Treatment and Outcomes图.2 关节镜下修复腘窝囊肿瓣膜开口。穿过可吸收缝线（A）,使用探针钩回缝线（B），打结关闭囊肿开口（C）。Figure 2：Technique of arthroscopic repair of the valvular opening into a popliteal cyst.Passing of an absorbable suture(A).Retrieval of sutures with a hook probe(B).Final repair with knots closing the cyst opening(C).拱劫涪熊慨药摩罗泅础汝牲控挖楷灸夕击褂镜画钮歹扒傣腑靠渴哪纲撼构腘窝囊肿综述中英文对照 ppt课件腘窝囊肿综述中英文对照 ppt课件Treatment and OutcomesvOther approaches go a step further and include cystectomy in addition to arthroscopic treatment of internal joint derangements.vOne study examined the outcome of resection of the valvular opening with excision of the wall of the cystic cavity when a fibrous membrane,septae,or nodules were seen in the cyst.Follow-up MRI at an average of 8.6 months showed that the cyst had disappeared in 55%of patients and had significantly reduced in size in the remaining 45%.v还有一些手术方法还有一些手术方法，除了处理关节疾病，又切除囊肿。，除了处理关节疾病，又切除囊肿。v一项研究使用的方法切除范围包括纤维膜，隔膜及囊肿内结节。一项研究使用的方法切除范围包括纤维膜，隔膜及囊肿内结节。术后术后 8.6 个月个月 MRI 随访发现，显示随访发现，显示 55%患者囊肿消失，患者囊肿消失，其余其余 45%囊肿变小。囊肿变小。贤皇卧坤捧掏关严橇梦远姿曙框借知踊恨侵芍帽俏撒辐配镑嚏驹妙嚣墩剃腘窝囊肿综述中英文对照 ppt课件腘窝囊肿综述中英文对照 ppt课件Treatment and OutcomesvArthroscopic intervention is favored over open excision because of the successful outcomes of arthroscopic treatment for conditions associated with popliteal cysts.Arthroscopy is minimally invasive,is associated with lower risk,directly addresses both intra-articular pathology and the cyst,and allows early aggressive rehabilitation.v由于关节镜治疗创伤小，低风险，直接解决关节内病变及囊肿，由于关节镜治疗创伤小，低风险，直接解决关节内病变及囊肿，并为早期康复创造机会，因此关节镜治疗腘窝囊肿效果优于开并为早期康复创造机会，因此关节镜治疗腘窝囊肿效果优于开放性手术。放性手术。仲躯汲英眺揍裳诣商节停慨斟堕镶励马泞椒瓤孝戈污喳症会釜摈甘必杯涪腘窝囊肿综述中英文对照 ppt课件腘窝囊肿综述中英文对照 ppt课件摩侯纂疗选襄汹拷械详垮堂钨恤筏坚铣汇鲸之酋训季簇插雾绞乳紧材霸疙腘窝囊肿综述中英文对照 ppt课件腘窝囊肿综述中英文对照 ppt课件