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,1,PoplitealCysts:ACurrentReviewAlyssaM.Herman,BS;JohnM.Marzo,MD,ZhuxiTheOrthopaedicsofGeneralHospitalofNMU,TheauthorsarefromtheDepartmentofExerciseandNutritionSciences(AMH)andtheDepartmentofOrthopaedics(JMM),UniversityatBuffalo,Buffalo,NewYork.,Orthopedics,腘窝囊肿综述中英文对照,2,Abstract,Ofthepossiblecysticlesionsaroundthekneejoint,poplitealcystsarethemostprevalent.Poplitealcystsmostcommonlyformbydistentionofthegastrocnemio-semimembranosusbursa,whichislocatedinthemedialaspectofthepoplitealfossa.ThesecystsarealsoreferredtoasBakerscysts,anamegiventotheconditionafterBakersclassiccasedescriptionofpoplitealswelling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-半膜肌滑囊膨胀形成，最早由Baker报道，又称Bakers囊肿。,腘窝囊肿综述中英文对照,3,Abstract,Thegastrocnemio-semimembranosusbursaissituatedbetweenthetendonsofthegastrocnemiusandsemimembranosusmusclesandisanormalanatomicfinding.腓肠肌-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。,腘窝囊肿综述中英文对照,4,Abstract,Thisbursahasbeenfoundtocommunicatewiththekneejointcapsuleviaatransverseopeningintheposteriorcapsuleatthelevelofthemedialfemoralcondyle,wherethegastrocnemiustendonmergeswiththejointcapsule.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。且腓肠肌肌腱与膝关节囊在股骨内侧髁处相连。,腘窝囊肿综述中英文对照,5,Abstract,Mostoften,thisopeningtakestheshapeofahorizontalslitmeasuring4to24mm.Thecommunicationbetweenthebursaandthejointcapsuleisalmostnonexistentinchildren,andthepresenceofthisopeningincreasesinfrequencywithage.横孔通常是4到24毫米大小的水平裂缝。滑膜囊腔通常在儿童阶段并不与关节腔相通，随着年龄的增加，出现缺口的几率也增加。,腘窝囊肿综述中英文对照,6,Abstract,Theintegrityofthejointcapsuledecreaseswithage,anditistheorizedthatthisopeningresultsfromatearinthedegeneratedjointcapsule.Rauschningobservedthat,whennoopeningwasfound,capsularthinningwasseeninthesameareaandnotedthatthecystissimplyaherniationofsynovium,asoriginallypostulatedbyBaker.膝关节囊完整性随着年龄增加而减低，有理论认为缺口是由于退化的膝关节囊撕裂后所致。Rauschning观察到，对无关节缺口的人群，在囊肿的同一区域仍可观察到关节囊，提示腘窝囊肿可能是贝克最初假设的滑膜疝出所致。,腘窝囊肿综述中英文对照,7,Abstract,Atrueganglioncystcanform,usuallybyfluidleakagethroughahorizontalorobliquemedialmeniscustear,formingawallofdensefibrousconnectivetissue(notsynovium)asadistinguishingfeature(Figure1).真正腱鞘囊肿通常是液体从斜行或水平内侧半月板裂隙渗出形成，其明显的特征是形成厚厚的纤维连接组织壁（不是滑膜）（图.1）。,腘窝囊肿综述中英文对照,8,Abstract,腘窝囊肿综述中英文对照,9,Abstract,Thecommunicationbetweenthegastrocnemio-semimembranosusbursaandthejointcapsule,whichallowsforthemovementofsynovialfluidbetweenthe2spaces,hasbeenshownbyarthrography.Avalvelikemechanismthatallowsonlyunidirectionalflowfromthejointintothebursahasbeenfoundinsomeoftheseopenings.关节造影术显示，关节液在腓肠肌-半膜肌滑囊与膝关节囊互通的两个腔隙之间运动。在有些互通缺口中发现类瓣膜机制，只允许关节液单方向流向滑囊。,腘窝囊肿综述中英文对照,10,Abstract,Intra-articularandintracysticpressuremeasurementshavebeenmadeinthekneesofpatientswithrheumatoidarthritiswhohavepoplitealcysts，andineverycaseintracysticpressurewashigherthanintra-articularpressure.Thesefindingsoffluidaccumulatinginthepoplitealcystandnotbeingabletoleave,despitehighpressure,indicatethepresenceofa1-wayvalve-typemechanism.测量类风湿患者腘窝囊肿内压和关节内压发现，所有患者囊肿内压高于关节内压。这些发现提示，液体积聚在囊肿内，尽管内压高，但并不流走，表明存在单向瓣膜机制。,腘窝囊肿综述中英文对照,11,ClinicalPresentation,Inchildren,apoplitealcystismostoftenanincidentalfindingonphysicalexamination.Occasionallyachildorparentseesorfeelsacystandbecomesconcernedaboutthepresenceofamass.儿童中，腘窝囊肿常在体检中偶然发现。有时父母因肿块（囊肿）发现囊肿。,腘窝囊肿综述中英文对照,12,ClinicalPresentation,Typicaladultclinicalpresentationisvagueposteriorkneepain,possiblelocalizedswellingormass,andafeelingoftightnessinthepoplitealregion.Physicalexaminationmayshowatenderpalpablemassinthemedialpoplitealfossa,althoughthisfindingissubjectiveandissomewhatdependentonthephysiciansopinionandexperience。成人临床常表现为膝后部隐约痛，局部肿胀及肿块，腘窝区域紧张感。物理查体可以发现在内侧腘窝可触及柔软肿块。这还有赖于医生主观的经验。,腘窝囊肿综述中英文对照,13,ClinicalPresentation,Mostcystsarefoundonthemedialsideoftheposteriorkneeandarereportedmorerarelyonthelateralside.Thecystisusuallyrounded,smooth,andfluctuant,andmayfeeltenseinextension,butthisisadifficultfindingtoquantify.ThishardnessofthecystinfullextensionfollowedbysofteningwithkneeflexionisknownasFoucherssign囊肿在膝关节后内侧，很少在外侧，呈圆形，光滑，波动感，扩张时可能紧张，但是这很难量化。膝关节伸直时，囊肿变硬，屈曲时软化，称为Foucher征。,腘窝囊肿综述中英文对照,14,ClinicalPresentation,CalfpainandswellingarealsopresentinDVTorsuperficialthrombophlebitis,andtheclinicalimperativeistoruleoutDVTwithappropriatediagnosticimagingstudies.PseudothrombophlebitishasthesameclinicalpresentationasDVTorsuperficialthrombophlebitis,butiscausedbyanothercondition，suchasarupturedpoplitealcyst.DVT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DVT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。,腘窝囊肿综述中英文对照,15,ClinicalPresentation,Discolorationorecchymosisinthecalf,atthemedialmalleolus,oronthedorsumofthefootisadistinguishingfeatureofarupturedcystbecausebloodysynovialcystfluiddissectsinferiorly.Treatmentofrupturedcyststypicallyinvolvestreatingresultantcomplications,butrupturedcystswithoutcomplicationshavebeenreportedtoresolvespontaneouslywithsupportiveconservativecare,suchascompressionandelevationofthelimb.在小腿，内踝或是足背出现变色或是瘀斑是囊肿破裂的特异性特征。囊肿破裂后治疗通常是治疗相应的并发症，然而无并发症的破裂囊肿在保守支持治疗下可自行缓解，如抬高或加压患肢。,腘窝囊肿综述中英文对照,16,DiagnosticImaging,Multipleimagingtechniquesmaybeusedinthediagnosisandassessmentofapoplitealcyst.Plainradiographsaresimpleandreadilyavailable,buttheyprovidelimitedinformationaboutthepoplitealcyst.However,theymayhelpinidentifyingassociatedarticulardisorders,suchasloosebodiesinthecystorthegeneralfindingsofosteoarthritisandinflammatoryarthritis.诊断和评估腘窝囊肿可采用多种影像学方法。平片简单易行，仅能提供有限的信息。但有助于鉴别相关关节疾病，如囊内游离体，骨关节炎，关节炎。,腘窝囊肿综述中英文对照,17,DiagnosticImaging,Otherimagingtechniquesareoftenmoresuitablefordiagnosingpoplitealcysts.Previously,arthrographywascommonlyusedintheimagingofpoplitealcysts,butdisadvantagessuchastheinvasivenessoftheprocedureandthepossibilityofcontrastextravasationhavebeenmadeapparent.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。,腘窝囊肿综述中英文对照,18,DiagnosticImaging,Ultrasoundquicklybecameapopularreplacementforarthrographyinimagingforthepresenceofpoplitealcysts.Ultrasoundisreadilyavailable,relativelyinexpensive,andnoninvasive,anditinvolvesnoexposuretoradiation.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。,腘窝囊肿综述中英文对照,19,DiagnosticImaging,Ultrasound,however,isnotsensitivetointra-articularlesions,andsofurtherimagingisneededtoconfirmthepresenceofanassociatedinternalderangement.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。,腘窝囊肿综述中英文对照,20,DiagnosticImaging,Magneticresonanceimagingisconsideredthegoldstandardinthevisualizationandcharacterizationofmassesabouttheknee.AdistinctadvantageofMRIistheabilityofaxialimagestovisualizeafluid-filledneckofthecystcommunicatingwiththejoint(Figure1).MRI是鉴定膝关节周围肿块的金标准检查。MRI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.1）。,腘窝囊肿综述中英文对照,21,DiagnosticImaging,腘窝囊肿综述中英文对照,22,TreatmentandOutcomes,Therearemanytreatmentoptionsforpoplitealcysts,dictatedbytheunderlyingcauseandassociatedcondition.Sometimesnotreatmentorsimplesupportivemeasuresresultinspontaneousresolutionofthecystoratleastreductioninassociatedsymptoms.Ifnot,bothminimallyinvasiveandsurgicaltechniquesarealternatives.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，微创或外科手术均可选择。,腘窝囊肿综述中英文对照,23,TreatmentandOutcomes,Ultrasound-guidedaspirationwithcorticosteroidinjectionisarelativelylow-riskandsuccessfulprocedureforthetreatmentofkneeosteoarthritiscomplicatedwithapoplitealcyst.Anotheroptionisasimilarprocedureinwhichcorticosteroidisinjecteddirectlyintothepoplitealcyst.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。另一相似方法是直接向腘窝囊肿内注射皮质激素。,腘窝囊肿综述中英文对照,24,TreatmentandOutcomes,Morerecently,intra-articularcorticosteroidinjectionswerecomparedwithintracysticcorticosteroidinjectionsinpatientswithkneeosteoarthritis.Althoughbothmethodsaresuitabletreatmentoptionsinpatientswithkneeosteoarthritis,directinjectionintothepoplitealcystmayprovidegreaterreductionincystsize.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。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。,腘窝囊肿综述中英文对照,25,TreatmentandOutcomes,Althoughconservativeandminimallyinvasivemeasuresareavailabletotreatsomeoftheconditionsassociatedwithpoplitealcysts,notallmayimprovewithoutinvasiveintervention.Currently,arthroscopicproceduresaremostcommonlyusedtotreattheconditionsassociatedwithpoplitealcystsandtoaddresscystsdirectly.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，直接处理囊肿。,腘窝囊肿综述中英文对照,26,TreatmentandOutcomes,Theprimarygoalofsurgicalinterventioninsymptomaticpoplitealcystsistoresolvetheunderlyingintra-articularpathologyandreducechroniceffusion.Othersbelievethatpoplitealcystsarebesttreatedbyclosingthecommunicationtothecyst.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。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。,腘窝囊肿综述中英文对照,27,TreatmentandOutcomes,Patientsweretreatedarthroscopicallyformeniscaltears,chondrallesions,oracombination.Inadditiontotheseprocedures,anarthroscopicsuturingtechniqueviaanaccessoryposteromedialworkingportalwasperformedtoclosethecommunicationintothepoplitealcyst(Figure2).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.2）。,腘窝囊肿综述中英文对照,28,TreatmentandOutcomes,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）。,Figure2：Techniqueofarthroscopicrepairofthevalvularopeningintoapoplitealcyst.Passingofanabsorbablesuture(A).Retrievalofsutureswithahookprobe(