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腘窝原始神经外胚叶肿瘤一例报告

膝上外侧动脉穿支髂胫束皮瓣修复腘窝软组织缺损

目的 总结膝上外侧动脉穿支髂胫束皮瓣修复腘窝软组织缺损的疗效。 方法2009年1月－2011年8月，收治9例腘窝软组织缺损患者。男5例，女4例；年龄24～53岁，平均35.2岁。交通事故伤5例，热压伤2例，绞伤2例。新鲜创面3例，陈旧创面6例；伤后距皮瓣修复术8～24 d。软组织缺损范围5 cm × 3 cm～15 cm × 8 cm。采用大小为7 cm × 4 cm～20 cm × 8 cm的膝上外侧动脉穿支髂胫束皮瓣移位修复创面。供区直接缝合或游离植皮修复。 结果术后3例皮瓣远端坏死，对症处理后成活；其余皮瓣及供区植皮均顺利成活，创面Ⅰ期愈合。9例均获随访，随访时间8个月～2年3个月，平均1年7个月。腘窝外形良好，膝关节屈曲120～140°，伸直—5～0°。结论膝上外侧动脉穿支髂胫束皮瓣位置隐蔽，无需显露膝上外侧血管蒂，皮肤较薄，血供可靠，可切取面积较大，适用于腘窝软组织缺损的修复。

RECONSTRUCTION OF POSTBURN POPLITEAL FOSSA CONTRACTURES USING POPLITEAL FOSSA MIDDLE ARTERY PEDICLED FLAPS IN CHILDREN

Objective To investigate the characteristics of blood supply of popliteal fossa middle artery pedicled flaps and the feasibility of reconstruction of postburn popliteal fossa contractures using the flaps in children. Methods Between January 2008 and October 2010, 6 cases of postburn popliteal fossa contractures were recontructed using popliteal fossa middle artery pedicled flaps. Of them, 2 were boys and 4 were girls, aged from 2 years and 2 months to10 years. All burns were caused by hot water. The wound ranged from 5 cm × 4 cm to 10 cm × 8 cm after scar relaxation. The size of the flap ranged from 6 cm × 4 cm to 11 cm × 9 cm. Donor sites were covered with split-thickness skin graft in 5 cases, and sutured directly in 1 case. Results All the flaps and the skingraft survived; no vascular crisis or flap necrosis occurred. All incisions at donors and wounds healed by first intention. All patients were followed up 12-24 months. The color, texture, and appearance of the flaps were good. Hyperplastic scar was found at incision of popliteal fossa in 1 case at 6 months after operation; the range of motion (ROM) of the knee joint was 0-175°, and no obvious change was observed at 15 months after operation. The others had no functional disturbance of the knee joints or claudication; the ROM of the knee joint was 0-180°. Conclusion The popliteal fossa middle artery pedicled flap has reliable blood supply, simple operative procedure, and good results in reconstruction of popliteal fossa contracture.

囊肿切除联合关节镜下有限清理术治疗成人腘窝囊肿

目的 总结囊肿切除后关节镜下有限清理术治疗成人腘窝囊肿的方法及临床疗效。 方法 2006 年4 月－ 2008 年10 月，对12 例腘窝囊肿伴膝部症状患者采用囊肿切除后于膝关节镜下有限清理术治疗。男5 例，女7 例；年龄46 ～ 65 岁，平均53 岁。腘窝囊肿均为单侧，其中左膝5 例，右膝7 例。骨性关节炎8 例，类风湿性关节炎2 例，痛风性关节炎2 例。病程3 ～ 18 个月，平均9 个月。根据Rauschning 等评价方法分级，Ⅰ级1 例，Ⅱ级6 例，Ⅲ级5 例。囊肿大小为6.5 cm × 4.5 cm ～ 7.2 cm × 5.0 cm。 结果 患者住院时间7 ～ 12 d，平均9 d。术后切口均Ⅰ期愈合，无血管、神经损伤。12 例均获随访，随访时间6 ～ 24 个月，平均18 个月；随访期间未见囊肿复发。术后6 个月根据Rauschning等评价方法分级：0 级8 例，Ⅰ级3 例，Ⅱ级1 例；手术前后差异有统计学意义（Z=—2.810，P=0.023）。 结论 成人腘窝囊肿多继发于关节内病变，切除腘窝囊肿的同时应处理关节内病变；关节镜辅助治疗腘窝囊肿具有创伤小、恢复快、复发率低、并发症发生率低的优点。

ANATOMIC BASIS OF POSTERIOR FEMORAL NEUROCUTANEOUS VASCULAR FLAP PEDICLED WITH DIRECT POPLITEAL ARTERY PERFORATOR

Objective To provide the anatomical basis for posterior femoral neurocutaneous vascular flap pedicled with direct popliteal artery perforator. Methods A total of 30 embalmed lower limbs of adult cadavers perfused with red latex were dissected and measured to observe the course and distribution of posterior femoral cutaneous nerve (PFCN), and the anastomoses between direct popliteal artery perforator and nutrient vessels of PFCN. Mimic operation was performed on 1 side of fresh specimen. Results PFCN started from the midpoint of the inferior gluteus maximus edge, and went down along the middle line of posterior thigh region, and the final trunk of PFCN accompanied with small saphenous vein down to the middle line of lower leg. The diameters of PFCN was (3.0 ± 0.6) mm at the inferior gluteus maximus edge, and was (2.0 ± 0.7) mm at the superior fossa poplitea. The nutrient vessels of PFCN were multi-segmental and polyphyletic. The direct popliteal artery perforator which started from popliteal artery directly was constant pierced into deep fascia about 7-11 cm above the knee joint, and its original diameter was (0.8 ± 0.2) mm. The direct popliteal artery perforator had 1-2 accompanying veins, and this perforator artery was the main nutrient vessel of the inferior segment of PFCN. The direct popliteal artery perforator gave off 5-8 small vessels which anastomosed with the 1st-3rd perforator of deep femoral artery, the obturator artery perforator, and the lateral femoral circumflex artery perforators. Then these nutrient vessels formed vascular plexus along PFCN in the middle line of posterior region of thigh. Mimic operation showed that the posterior femoral neurocutaneous vascular flap pedicled with direct poplitea artery perforator could be formed successfully. Conclusion The posterior femoral neurocutaneous vascular flap pedicled with direct popliteal artery perforator has constant blood supply and can be easily formed to repair defects around knee joint.

关节镜下后入路射频气化治疗腘窝囊肿临床观察

【摘要】 目的 探讨关节镜下后入路巨大腘窝囊肿(直径gt;5 cm)切除术的方法和临床效果。方法 2004年8月—2008年9月将39例腘窝囊肿直径＞5 cm分为两组。关节镜组20例行后入路关节镜下射频气化切除,不结扎囊肿蒂部；开放手术组19例行开放手术治疗,并结扎囊肿蒂部。结果 关节镜组术后平均住院时间、切口瘢痕大小均优于开放手术组(Plt;0.01)。39例患者随访18～36个月,平均26个月。两组术后复发率、术后临床评价囊肿分级改善率差异无统计学意义 (Pgt;0.05),且复发率与囊肿蒂部结扎与否无关。结论 关节镜下后入路射频气化巨大腘窝囊肿切除术操作安全、创伤小、痛苦少,术后瘢痕小,不影响美观,有利于早期功能锻炼。该术式与开放手术同样可靠,值得推广应用。

彩色多普勒高频超声对腘窝滑膜囊肿的诊断价值

目的探讨彩色多普勒高频超声对腘窝滑膜囊肿诊断的声像图特征及临床指导意义。 方法分析总结2009年11月－2012年12月经彩色多普勒高频超声诊断为腘窝滑膜囊肿的71例患者的声像图，并对全部患者进行随访。 结果71例腘窝滑膜囊肿患者中，经手术及病理证实69例，彩色多普勒高频超声诊断腘窝滑膜囊肿确诊率97.2%，囊肿因较小经抗炎治疗明显缩小、消失2例，未行手术治疗。 结论彩色多普勒高频超声对腘窝囊肿的诊断、分型、鉴别诊断有重要价值，能为临床治疗提供可靠信息，并可作为术前超声及术后随访的首选检查方法。

高频超声在关节镜治疗与膝关节相通腘窝囊肿中的临床价值

目的探讨高频超声对与膝关节相通腘窝囊肿的诊断并指导采用关节镜治疗疗效观察的临床价值。 方法回顾分析2010年5月－2013年11月高频超声诊断的32例与膝关节相通腘窝囊肿合并膝关节内病变的影像学特征并观察随访术后疗效。 结果高频超声诊断与膝关节相通腘窝囊肿与关节镜诊断符合率高，达93.75%。关节镜内引流术后随访6～18个月，术后功能恢复良好，未见囊肿复发。 结论高频超声具有诊断准确率高、无创、方便、可重复性强等优点，可作为关节镜内引流术治疗腘窝囊肿患者筛查及术后评价疗效的首选检查方法。

CLINICAL APPLICATION OF LINK-PATTERN LATERAL POPLITEAL ARTERY PERFORATOR FLAP IN REPAIR OF POPLITEAL FOSSA SCAR

ObjectiveTo discuss the feasibility and effectiveness of link-pattern lateral popliteal artery perforator flap in repairing popliteal fossa scar contracture in children or teenagers. MethodsBetween January 2009 and January 2013, 12 patients with popliteal fossa scar were admitted. Of them, 7 cases were male and 5 cases were female, aged from 3 to 17 years (median, 12 years). The disease duration was from 6 months to 5 years (median, 3 years). Wound was repaired with link-pattern lateral popliteal artery perforator flap after remission of popliteal fossa scar. The wound ranged from 6 cm×4 cm to 10 cm×7 cm, and the flap size ranged from 7 cm×4 cm to 12 cm×9 cm. The flap was with lateral sural cutaneous nerve in 5 cases, and lateral sural cutaneous nerve was retained at the donor area of 7 cases. The donor site was repaired using split-thickness skin graft. ResultsAll pedicled flaps and skin graft survived smoothly after operation. The wound at donor site healed by first intention. All the cases were followed up 12-36 months, with an average of 18 months. The flaps had good color, texture, and shape; scar obviously became softened, without hyperplasia or ulceration. The patients were free from lameness with knee range of motion of 0-180°. The squatting function was normal. Grafting skin was smooth in the donor area of the calf, without depression or scar hyperplasia. The senses of posterior-inferior calf and lateral of foot decreased or disappeared in 5 cases of flaps with lateral sural cutaneous nerve; at 6 months after operation, two-point discrimination was 12-14 mm (mean, 13 mm). The posterior-inferior calf was numb and discomfort in 7 cases of flaps with retained lateral sural cutaneous nerve; but after 3-6 months, the sense was obviously recovered, with no sense loss; at 6 months after operation, two-point discrimination was 5-7 mm (mean, 6 mm). ConclusionLink-pattern lateral popliteal artery perforator flap has reliable blood supply and the operation was simple. The cutaneous nerve can be retained in donor area. It is an ideal method for repairing wound after remission of popliteal fossa scar in children or teenagers.

ARTHROSCOPIC TREATMENT OF POPLITEAL CYST EXCISION IN COMBINATION WITH DEBRIDEMENT OF THE KNEE UNDER LOCAL ANESTHESIA

ObjectiveTo evaluate the arthroscopic treatment effectiveness of popliteal cyst excision in combination with debridement of the knee under local anesthesia by comparing with continuous epidural anesthesia. MethodsBetween June 2002 and January 2013,145 patients with popliteal cyst underwent arthroscopic popliteal cyst excision in combination with debridement of the knee under local anesthesia (local anesthesia group).In addition,51 patients with popliteal cyst were treated with the same surgery under continuous epidural anesthesia between February 2000 and August 2005 served as control group.No significant difference was found in gender,age,side,disease duration,or cyst size between 2 groups (P>0.05).Then,anesthesia time,analgesia effect,anesthesia satisfaction,operation time,bleeding volume,and anesthesia complication were compared between 2 groups.The guidelines of Rauschning and Lindgren were used to assess the effectiveness,and recurrence rate was recorded. ResultsAll incisions healed primarily,no neurological or vascular injury was found.The patients were followed up 1 year and 1 month to 8 years (mean,3.7 years) in local anesthesia group,and 8 years to 13 years and 7 months (mean,10.8 years) in control group.Local anesthesia group had shorter anesthesia time,higher visual analogue scale (VAS) score,shorter operation time,and lower bleeding volume (P<0.05) than control group.Anesthesia satisfaction was reduced in local anesthesia group,but there was no significant difference (χ2=0.071,P=1.000).The anesthesia complication incidence of control group (15.7%,8/51) was significantly higher than that of local anesthesia group (0) (P=0.000).Recurrence was found in 12 patients of local anesthesia group (curative ratio 91.7%) and in 5 patients of control group (curative ratio 90.2%),showing no significant difference (χ2=0.111,P=0.774).According to the guidelines of Rauschning and Lindgren,there were 131 cases of grade 0,13 cases of grade I,and 1 case of grade Ⅱ in local anesthesia group,and 37 cases of grade 0,12 cases of grade I,and 2 cases of grade Ⅱ in control group; significant differences in grading were shown between at pre- and post-operation in 2 groups (Z=-10.683,P=0.000; Z=-6.385,P=0.000),and between 2 groups at post-operation (Z=-3.145,P=0.002). ConclusionCompared with under continuous epidural anesthesia,arthroscopic treatment of popliteal cyst excision under local anesthesia can obtain better results.Under local anesthesia,the condition of nerve and vessel can be timely and dynamically observed.Arthroscopic treatment of popliteal cyst excision in combination with debridement of the knee has the advantages of less trauma,lower recurrence rate,and satisfactory results.