目的:比较传统切开手术与关节镜技术在治疗坐骨结节囊肿中的临床应用.方法:自2014年5月至2016年9月对49例坐骨结节囊肿患者采用信封法分为关节镜组和传统切开组.关节镜组24例,男16例,女8例,年龄42～81(64.1±9.3)岁,病程2～36(17.0±9.1)个月,在囊肿周围建立人工腔隙,关节镜下刨削清理囊肿壁.传统切开组25例,男11例,女14例,年龄47～79(61.2±10.6)岁,病程4～36(17.5±8.5)个月,分别于术后1d、1周、1个月时采用肿块表面横行切口,分离切除肿块.比较两组患者手术时间、术后引流量、术后住院天数、术后并发症,并采用疼痛视觉模拟评分(VAS)进行疼痛评价.结果:49例患者均获得随访,时间6～18(11.3±3.3)个月.传统切开组2例出现术后切口感染,1例术后复发,关节镜组均Ⅰ期愈合;关节镜组手术时间、术中出血量、术后引流量、住院天数分别为(54.7±7.7)min、(20.8±3.5)ml、(20.3±5.6)ml、(2.8±0.6)d,均明显优于传统切开组的(71.8±8.8) min、(67.3±12.0) ml、(103.6±20.3)ml、(7.8±2.9)d.关节镜组术后1d、1周、1个月VAS评分为(2.6±0.7、0.5±0.6、0.3±0.5)显著低于传统切开组的(6.0±0.7、3.0±1.0、1.1±1.0),差异有统计学意义(P＜0.05).两组患者术后并发症发生率比较差异无统计学意义(P＞0.05).结论:与传统切开手术相比,关节镜治疗坐骨结节囊肿具有创伤小、围手术期出血量少、术后疼痛程度轻、安全性高以及恢复快等特点,但要求术者有关节镜手术经验,值得在临床实践中推广使用.%Objective:To compare technique and clinical effect of arthroscopic and conventional sectional therapy for the treatment of ischial tuberosity cyst.Methods:From May 2014 and September 2016,49 patients with symptomatic ischialtuberosity cyst were randomized divided into arthroscopic group and conventional section group by envelope method.There were 24 patients in arthroscopic group,including 16 males and 8 females aged from 42 to 81years old with an average age of (64.1 ±9.3) years old;the courses of disease ranged from 2 to 36 months with an average of (17.0±9.1) months;treated with removing cyst wall under arthroscopic and build artificial lacuna around cyst.There were 25 patients in conventional section group,including 11 males and 14 females aged from 47 to 79 years old with an average of (61.2±10.6) years old;the courses of disease ranged from 4 to 36 months with an average of (17.5±8.5) months;treated with cutting off lump with transverse incision.Operative time,blood loss,fluid volume,hospital stays and postoperative complication were observed and compared,VAS score were applied to evaluate pain degree.Results:Forty-nine patients were followed up from 6 to 18 months with an average of (11.3±3.3) months.In conventional group,2 patients occurred incision infection,1 case reoccurred.All patients in arthroscopic group were healed at stage Ⅰ.Operative time,blood loss,fluid volume,and hospital stays in arthroscopic group were (54.7±7.7) min,(20.8±3.5) ml,(20.3±5.6) ml,(2.8±0.6) d respectively and better than that of conventional group (71.8± 8.8) min,(67.3±12.0) ml,(103.6±20.3) ml,(7.8±2.9) d.Postoperative VAS score in arthroscopic group on the first day,seventh days and first month were 2.6±0.7,0.5±0.6,0.3±0.5,and significantly lower than that of conventional group 6.0±0.7,3.0± 1.0,1.1±1.0 respectively(P＜0.05).There were no statistical difference in postoperative complications between two groups (P＞ 0.05).Conclusion:Compared with conventional group,arthroscopic for ischial tuberosity cyst has advantages of minimal invasive,less blood loss during perioperative period,less pain degree after surgery,safety and rapid recovery.But arthroscopic skills are needed for surgeons.It should be recommended in clinical practice.
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