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1、Click to edit Master text styles,Second level,Third level,Fourth level,Fifth level,*,Click to edit Master title style,Click to edit Master text styles,Second level,Third level,Fourth level,Fifth level,Click to edit Master title style,*,Click to edit Master text styles,Second level,Third level,Fourth

2、 level,Fifth level,*,Click to edit Master title style,Click to edit Master text styles,Second level,Third level,Fourth level,Fifth level,Click to edit Master title style,*,Popliteal Cysts:A Current Review,Alyssa M.Herman,BS;John M.Marzo,MD,Zhu xi,The Orthopaedics of General Hospital of NMU,The autho

3、rs are from the Department of Exercise and Nutrition Sciences(AMH)and the Department of Orthopaedics(JMM),University at Buffalo,Buffalo,New York.,Orthopedics,Abstract,Of the possible cystic lesions around the knee joint,popliteal cysts are the most prevalent.Popliteal cysts most commonly form by dis

4、tention 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 swelling,腘窩囊腫是膝關(guān)節(jié)周圍最常見的囊性病變。腘窩囊腫通常由腘窩內(nèi)側(cè)的腓腸肌-半膜肌滑囊膨脹形成，最早由 B

5、aker 報(bào)道，又稱 Bakers 囊腫。,Abstract,The gastrocnemio-semimembranosus bursa is situated between the tendons of the gastrocnemius and semimembranosus muscles and is a normal anatomic finding.,腓腸肌-半膜肌滑囊是位于腓腸肌、半膜肌肌腱之間的正常解剖組織。,Abstract,This bursa has been found to communicate with the knee joint capsule via a

6、 transverse opening in the posterior capsule at the level of the medial femoral condyle,where the gastrocnemius tendon merges with the joint capsule.,該滑囊通過(guò)一橫孔與膝關(guān)節(jié)囊腔相通，橫孔位于股骨內(nèi)側(cè)髁水平處的關(guān)節(jié)囊后部。且腓腸肌肌腱與膝關(guān)節(jié)囊在股骨內(nèi)側(cè)髁處相連。,Abstract,Most often,this opening takes the shape of a horizontal slit measuring 4 to 24 mm.T

7、he communication between the bursa and the joint capsule is almost nonexistent in children,and the presence of this opening increases in frequency with age,.,橫孔通常是 4 到 24 毫米大小的水平裂縫?；つ仪煌ǔＴ趦和A段并不與關(guān)節(jié)腔相通，隨著年齡的增加，出現(xiàn)缺口的幾率也增加。,Abstract,The integrity of the joint capsule decreases with age,and it is theori

8、zed 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,.,膝關(guān)節(jié)囊完整性隨著年齡增加而減低，有理論認(rèn)為缺口是由于退化的膝關(guān)節(jié)囊撕

9、裂后所致。Rauschning 觀察到，對(duì)無(wú)關(guān)節(jié)缺口的人群，在囊腫的同一區(qū)域仍可觀察到關(guān)節(jié)囊，提示腘窩囊腫可能是,貝克最初假設(shè)的,滑膜疝出所致。,Abstract,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).,真正腱鞘囊腫通常

10、是液體從斜行或水平內(nèi)側(cè)半月板裂隙滲出形成，其明顯的特征是形成厚厚的纖維連接組織壁,（不是滑膜）,（圖.1）。,Abstract,Abstract,The 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 u

11、nidirectional flow from the joint into the bursa has been found in some of these openings,.,關(guān)節(jié)造影術(shù)顯示，關(guān)節(jié)液在腓腸肌-半膜肌滑囊與膝關(guān)節(jié)囊互通的兩個(gè)腔隙之間運(yùn)動(dòng)。在有些互通缺口中發(fā)現(xiàn)類瓣膜機(jī)制，只允許關(guān)節(jié)液?jiǎn)畏较蛄飨蚧摇?Abstract,Intra-articular and intracystic pressure measurements have been made in the knees of patients with rheumatoid arthritis who have p

12、opliteal 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,.,測(cè)量類風(fēng)濕患者腘窩囊腫內(nèi)壓和關(guān)節(jié)內(nèi)壓發(fā)現(xiàn)，所有患者囊腫內(nèi)壓高于關(guān)節(jié)內(nèi)壓。,這

13、些發(fā)現(xiàn)提示，,液體積聚在囊腫內(nèi)，盡管內(nèi)壓高，但并不流走，表明存在單向瓣膜機(jī)制。,Clinical Presentation,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,.,兒童中，腘窩囊腫常在體檢中偶然發(fā)現(xiàn)。有時(shí)父母因腫塊,（囊腫）,發(fā)現(xiàn)囊腫。,Clinica

14、l Presentation,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 this finding is subjective and is somewha

15、t dependent on the physicians opinion and experience,。,成人臨床常表現(xiàn)為膝后部隱約痛，局部腫脹及腫塊，腘窩區(qū)域緊張感。,物理查體可以發(fā)現(xiàn),在內(nèi)側(cè)腘窩可觸及柔軟腫塊。,這還有賴于醫(yī)生主觀的經(jīng)驗(yàn)。,Clinical Presentation,Most 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 fl

16、uctuant,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 sign,囊腫在膝關(guān)節(jié)后內(nèi)側(cè)，很少在外側(cè)，呈圓形，光滑，波動(dòng)感，擴(kuò)張時(shí)可能緊張,，但是這很難量化。膝關(guān)節(jié)伸直時(shí)，囊腫變硬，屈曲時(shí)軟化，稱為 Foucher 征。,Clinical Presentation,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