腘窝囊肿综述中英文对照-课件.ppt
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1、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.OrthopedicsAbstractv Of the po
2、ssible 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
3、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。Abstractv The gastrocnemio-semimembranosus bursa is situated between the tendons of the gastrocnemi
4、us 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。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,wh
5、ere 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。Abstractv Most often,this opening takes the shape of a horizontal slit measuring 4 to 24 mm.The communication between the burs
6、a 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 毫米大小的水平裂缝。滑膜囊腔通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。缺口的几率也增加。Abstractv The integrity of the joint capsule decreases wit
7、h 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 膝关节囊完整性随着年龄增加
8、而减低,有理论认为缺口是由于退化的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。膝关节囊撕裂后所致。Rauschning 观察到,对无关节缺口的人群,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贝克最初假设的假设的滑膜疝出所致。滑膜疝出所致。Abstractv A true ganglion cyst can form,usually by fluid leakage through a horizontal or oblique medial meniscus t
9、ear,forming a wall of dense fibrous connective tissue(not synovium)as a distinguishing feature(Figure 1).v真正腱鞘囊肿通常是液体从斜行或水平内侧半月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维连接组织壁(不是滑膜)(不是滑膜)(图(图.1)。)。AbstractAbstractv The communication between the gastrocnemio-semimembranosus
10、 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 关节造影术显示,关节液在腓肠肌关节造影术显示,关节液在腓肠肌-半膜肌滑囊与膝关
11、节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。膜机制,只允许关节液单方向流向滑囊。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
12、 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 测量类风湿患者腘窝囊肿内压和关节内压发现,所有患者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。囊肿内压高于关节内压。这些发现提示,这些发现提示,液体积聚在囊肿液体积聚在囊肿内,尽管
13、内压高,但并不流走,表明存在单向瓣膜机制。内,尽管内压高,但并不流走,表明存在单向瓣膜机制。Clinical Presentationv In 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,腘窝囊肿常在体检中偶然发现。有时父母因肿块儿童中,腘窝囊肿常在体检
14、中偶然发现。有时父母因肿块(囊肿)(囊肿)发现囊肿。发现囊肿。Clinical Presentationv Typical 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 th
15、is finding is subjective and is somewhat dependent on the physicians opinion and experience。v 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。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。物理查体可以发现物理查体可以发现在内侧腘窝可触及柔软肿块。在内侧腘窝可触及柔软肿块。这还有赖于医生主观这还有赖于医生主观的经验。的经验。Clinical Presentationv Most cysts are found on the medial side of the poster
16、ior 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 囊肿在膝关节
17、后内侧,很少在外侧,呈圆形,光滑,波动囊肿在膝关节后内侧,很少在外侧,呈圆形,光滑,波动感,扩张时可能紧张感,扩张时可能紧张,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。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 di
18、agnostic 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.v 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
19、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。Clinical Presentationv Discoloration 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.v Treatment of ruptured cysts t
20、ypically 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,内踝或是足背出现变色或是瘀斑是囊肿破裂的特异性特征。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。v 囊肿破裂后治疗通常是治疗相应的并发症,然
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