该研究得到了河北省卫生厅青年科技项目的支持。（第20201046号）。

该方案遵循河北医科大学第三医院伦理委员会的指导方针。已获得患者的知情同意，以纳入他们和作为本研究一部分生成的数据。参加这项研究的患者年龄在 18-60 岁之间。该研究共纳入8名患者，5名女性和3名男性。
1.术前准备
<ol><li>使用以下纳入和排除标准将患者纳入本研究。<ol><li>使用这些纳入标准:通过膝关节 MRI 明确诊断为后交叉韧带囊肿的患者;有明显膝关节疼痛、过伸展疼痛和其他可能由后交叉韧带囊肿引起的症状的患者或需要关节镜治疗的合并半月板损伤患者;由于手术对他们的生活质量有影响而对手术感兴趣的患者。</li>
		<li>使用以下排除标准: 患有其他严重疾病且无法耐受手术的患者;拒绝手术治疗的患者;经MRI诊断为后交叉韧带囊肿但无症状的患者;联合前交叉韧带断裂或后交叉韧带断裂的患者。</li>
	</ol></li>
	<li>对所有患者使用全身麻醉或椎管内麻醉。将患者置于手术床上的仰卧位。将止血带套在大腿中部和上部的患肢上不超过 1 小时。用碘伏对患肢消毒 2 次，并铺设手术片。</li>
</ol>2. 关节镜入路的建立
<ol><li>使用驱血带将血液从患肢排出。从肢体末端到近端收紧驱血带。使每圈重叠 1/3。不要在每圈之间插入软组织。从手术肢体的软组织中排出血液。通过施加 50 kPa 的压力/力给止血带充气。</li>
	<li>建立前外侧通路，在膝外侧线上方 1 cm，髌腱缘外侧 1 cm。使用 0.5G 锋利刀片从皮肤到关节腔做一个约 11 厘米大小的切口。</li>
	<li>建立前内侧入路，在膝关节内侧关节线上方 1 cm，髌腱缘内侧 1 cm。使用 0.5G 锋利刀片从皮肤到关节腔做一个约 11 厘米大小的切口。</li>
	<li>将平行于胫骨平台的关节镜分别插入内侧和外侧进路朝向髁间窝。探查髌上关节囊、髌股关节、内侧转子清除、外侧转子沟、前交叉韧带、后交叉韧带、内侧半月板和外侧半月板。</li>
	<li>部分切除受伤的半月板或缝合受伤的半月板。拆下无接头主体。治疗关节内的所有损伤。</li>
	<li>建立正常的后内侧入路，如下所述。<ol><li>将膝盖弯曲 90°。将关节镜检查插入前内侧入路，以监测髁间窝，并将切换杆置于前外侧入路。</li>
		<li>在关节镜监测下，将后交叉韧带 （PCL） 和股内侧髁之间的交换棒插入后内侧关节囊。通常会有明显的滑入和滑出的感觉。</li>
		<li>将晶状体旋转到内侧后关节囊。见关节囊反向折叠形成的三角形区域、股内侧髁突和内侧半月板。</li>
		<li>关掉手术室的灯。观察膝关节后内侧皮肤表面的半透明区域（图2）。</li>
		<li>使用腰椎针辅助定位（图 3）。在半透明区域（通常位于股骨后髁后方和关节线近端）偏心穿刺到关节囊中。</li>
		<li>使用11G锋利刀片在皮肤上做一个约0.5厘米的小切口。在关节镜监测下将直夹插入关节囊。建立正常的后内侧入路。</li>
	</ol></li>
	<li>建立高后内侧入路，如下所述。<ol><li>将关节镜检查插入后内侧入路。将腰椎针插入关节方向，位于后内侧入路近端 2-3 厘米处。</li>
		<li>使腰椎针穿入内侧后髁、内侧半月板和后关节囊的三角形空间中的关节囊。</li>
		<li>在皮肤上做一个小切口。在关节镜监测下将直夹插入关节囊。建立高位后内侧入路。</li>
	</ol></li>
</ol>3.暴露和切除后交叉韧带囊肿
<ol><li>将关节镜检查插入高位后内侧入路。以正常的后内侧入路插入剃须刀（图 4）。</li>
	<li>使用剃须刀去除后交叉韧带和关节囊之间的滑膜组织。</li>
	<li>找到囊肿，它是后交叉韧带周围的半透明，凸起的滑膜（图1C）。切除囊肿壁，看到黄色和半透明的液体从囊肿壁流出，看到囊肿中的隔室状组织。</li>
	<li>完全切除后囊肿壁。避免损伤后交叉韧带和后血管和神经，并探索后交叉韧带而不受伤。</li>
	<li>在前外侧入路插入关节镜检查。在后交叉韧带的股骨末端看到囊肿的一部分。</li>
	<li>切除前囊肿壁，看到黄色和半透明的液体从囊肿壁流出。完全切除囊肿壁。</li>
	<li>切除前交叉韧带和后交叉韧带之间的 V 形空间中的滑膜组织。探查后交叉韧带并检查后交叉韧带是否损伤。</li>
	<li>将关节镜检查插入髌内侧入路。检查前交叉韧带和后交叉韧带之间的 V 形空间是否有残留的囊肿。</li>
	<li>在后内侧入路插入关节镜检查。检查有无残留囊肿。</li>
</ol>4. 切口闭合
<ol><li>将关节镜鞘插入前外侧入路。挤压髌上关节囊，完全排出关节内液。检查 0° 到 120° 的膝关节伸展和屈曲活动。</li>
	<li>用 4 号丝线缝合切口。</li>
</ol>5.术后康复
<ol><li>股四头肌锻炼:要求患者以仰卧位进行此锻炼。伸直患肢，勾起脚趾，慢慢将腿向上抬起至脚后跟约 15 厘米的高度，停留 3 秒钟，然后慢慢放下。</li>
	<li>关节释放训练:要求患者在坐在床边时进行此操作，并自行伸展和弯曲膝关节。</li>
	<li>要求患者在手术后第二天下床并适当活动，并逐渐恢复正常活动。</li>
	<li>手术后每 3 天更换一次敷料，手术后 14 天拆线。</li>
	<li>要求患者在手术后第一个月进行非对抗性活动，例如慢跑，并在手术后第三个月恢复正常活动。</li>
</ol>6. 术后护理和随访
<ol><li>要求患者在手术后 6 小时内不带枕头平躺。病人住院了大约3天。</li>
	<li>术后3个月，检查患者活动度是否恢复正常，术后12个月，进行患膝MRI检查，结合关节镜检查，检查患膝是否有不适，囊肿是否复发。</li>
</ol>

关节镜双后内侧入路用于 PCL 囊肿切除术

<ol>
	<li>Deutsch, A., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Symptomatic+intraarticular+ganglia+of+the+cruciate+ligaments+of+the+knee.">Symptomatic intraarticular ganglia of the cruciate ligaments of the knee.</a> Arthroscopy. 10 (2), 219-223 (1994).</li><li>Zantop, T., Rusch, A., Hassenpflug, J., Petersen, W. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Intra-articular+ganglion+cysts+of+the+cruciate+ligaments:+Case+report+and+review+of+the+literature.">Intra-articular ganglion cysts of the cruciate ligaments: Case report and review of the literature.</a> Arch Orthop Trauma Surg. 123 (4), 195-198 (2003).</li><li>Garcia, A., Hodler, J., Vaughn, L., Haghighi, P., Resnick, D. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Case+report+667.+Intraarticular+ganglion+arising+from+the+posterior+cruciate-ligament.">Case report 667. Intraarticular ganglion arising from the posterior cruciate-ligament.</a> Skeletal Radiol. 20 (5), 373-375 (1991).</li><li>Garc&#237;a-Alvarez, F., Garc&#237;a-Pequerul, J. M., Avila, J. L., Sainz, J. M., Castiella, T. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Ganglion+cysts+associated+with+cruciate+ligaments+of+the+knee:+A+possible+cause+of+recurrent+knee+pain.">Ganglion cysts associated with cruciate ligaments of the knee: A possible cause of recurrent knee pain.</a> Acta Orthop Belg. 66 (5), 490-494 (2000).</li><li>Brown, M. F., Dandy, D. J. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Intra-articular+ganglia+in+the+knee.">Intra-articular ganglia in the knee.</a> Arthroscopy. 6 (4), 322-323 (1990).</li><li>Kim, M. G., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Intra-articular+ganglion+cysts+of+the+knee:+Clinical+and+MR+imaging+features.">Intra-articular ganglion cysts of the knee: Clinical and MR imaging features.</a> Eur Radiol. 11 (5), 834-840 (2001).</li><li>Kim, R. S., Kim, K. T., Lee, J. Y., Lee, K. Y. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Ganglion+cysts+of+the+posterior+cruciate+ligament.">Ganglion cysts of the posterior cruciate ligament.</a> Arthroscopy. 19 (6), e36-e40 (2003).</li><li>Shetty, G. M., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Ganglion+cysts+of+the+posterior+cruciate+ligament.">Ganglion cysts of the posterior cruciate ligament.</a> The Knee. 15 (4), 325-329 (2008).</li><li>DeFriend, D. E., Schranz, P. J., Silver, D. A. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Ultrasound-guided+aspiration+of+posterior+cruciate+ligament+ganglion+cysts.">Ultrasound-guided aspiration of posterior cruciate ligament ganglion cysts.</a> Skeletal Radiol. 30 (7), 411-414 (2001).</li><li>Krudwig, W. K., Schulte, K. K., Heinemann, C. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Intra-articular+ganglion+cysts+of+the+knee+joint:+A+report+of+85+cases+and+review+of+the+literature.">Intra-articular ganglion cysts of the knee joint: A report of 85 cases and review of the literature.</a> Knee Surg Sports Traumatol Arthrosc. 12 (2), 123-129 (2004).</li><li>Seki, K., Mine, T., Tanaka, H., Isida, Y., Taguchi, T. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Locked+knee+caused+by+intraarticular+ganglion.">Locked knee caused by intraarticular ganglion.</a> Knee Surg Sports Traumatol Arthrosc. 14 (9), 859-861 (2006).</li><li>Abreu, F. G., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Excision+of+a+posterior+cruciate+ligament+cyst+using+an+arthroscopic+trans-septal+approach.">Excision of a posterior cruciate ligament cyst using an arthroscopic trans-septal approach.</a> Arthrosc Tech. 9 (4), e581-e585 (2020).</li><li>Tsai, T. Y., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Arthroscopic+excision+of+ganglion+cysts+of+the+posterior+cruciate+ligaments+using+posterior+trans-septal+portal.">Arthroscopic excision of ganglion cysts of the posterior cruciate ligaments using posterior trans-septal portal.</a> Arthroscopy. 28 (1), 95-99 (2012).</li><li>Boushnak, M. n. O., Moussa, M. K., Abed Ali, A., Alayane, A., Bayoud, W. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=An+uncommon+finding+of+posterior+cruciate+ligament+intrasubstance+cyst:+A+case+report+and+review+of+literature.">An uncommon finding of posterior cruciate ligament intrasubstance cyst: A case report and review of literature.</a> J Orthop Case Rep. 12 (3), 61-63 (2022).</li><li>Jawish, R., Nemer, C., Assoum, H., Haddad, A. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Ganglion+cyst+of+the+anterior+cruciate+ligament+in+children.">Ganglion cyst of the anterior cruciate ligament in children.</a> J Pediatr Orthop B. 18 (5), 234-237 (2009).</li><li>Bui-Mansfield, L. T., Youngberg, R. A. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Intraarticular+ganglia+of+the+knee:+Prevalence,+presentation,+etiology,+and+management.">Intraarticular ganglia of the knee: Prevalence, presentation, etiology, and management.</a> Am J Roentgenol. 168 (1), 123-127 (1997).</li><li>Recht, M. P., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=The+MR+appearance+of+cruciate+ganglion+cysts:+A+report+of+16+cases.">The MR appearance of cruciate ganglion cysts: A report of 16 cases.</a> Skeletal Radiol. 23 (8), 597-600 (1994).</li><li>Dinakar, B., Khan, T., Kumar, A., Kumar, A. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Ganglion+cyst+of+the+anterior+cruciate+ligament:+A+case+report.">Ganglion cyst of the anterior cruciate ligament: A case report.</a> J Orthop Surg. 13 (2), 181-185 (2005).</li><li>Hameed, S. A., Sujir, P., Naik, M. A., Rao, S. K. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Ganglion+cyst+of+the+posterior+cruciate+ligament+in+a+child.">Ganglion cyst of the posterior cruciate ligament in a child.</a> Singapore Med J. 53 (4), e80-e82 (2012).</li><li>Tie, K., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Clinical+manifestation+and+arthroscopic+treatment+of+symptomatic+posterior+cruciate+ligament+cyst.">Clinical manifestation and arthroscopic treatment of symptomatic posterior cruciate ligament cyst.</a> J Orthop Surg Res. 13 (1), 84 (2018).</li><li>Lankes, M., Petersen, W., Hassenpflug, J. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Arterial+supply+of+the+femoral+condyles.">Arterial supply of the femoral condyles.</a> Z Orthop Ihre Grenzgeb. 138 (2), 174-180 (2000).</li><li>McCarthy, M. M., Hannafin, J. A. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=The+mature+athlete:+Aging+tendon+and+ligament.">The mature athlete: Aging tendon and ligament.</a> Sports Health. 6 (1), 41-48 (2014).</li><li>Petersen, W., Tillmann, B. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Blood+and+lymph+supply+of+the+posterior+cruciate+ligament:+A+cadaver+study.">Blood and lymph supply of the posterior cruciate ligament: A cadaver study.</a> Knee Surg Sports Traumatol Arthrosc. 7 (1), 42-50 (1999).</li><li>Simank, H. G., Graf, J., Schneider, U., Fromm, B., Niethard, F. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Demonstration+of+the+blood+supply+of+human+cruciate+ligaments+using+the+plastination+method.">Demonstration of the blood supply of human cruciate ligaments using the plastination method.</a> Z Orthop Ihre Grenzgeb. 133 (01), 39-42 (1995).</li><li>Tang, C., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Surgical+techniques+in+the+management+of+pediatric+anterior+cruciate+ligament+tears:+Current+concepts.">Surgical techniques in the management of pediatric anterior cruciate ligament tears: Current concepts.</a> J Child Orthop. 17 (1), 12-21 (2023).</li></ol>

作者声明，本研究不存在利益冲突。

后交叉韧带囊肿是一种罕见的疾病。膝关节韧带囊肿通常是在 MRI 或膝关节镜检查中发现的。膝韧带囊肿形成的原因是多种多样的，包括创伤后形成、胚胎发生过程中滑膜组织疝的形成以及间充质干细胞的增殖和形成。最近，创伤和组织刺激已被大多数专家认可 2,7,14。
大多数后交叉韧带囊肿患者无症状，?...

关节囊肿是囊性病变，囊肿液是一种透明的果冻状液体，可见于韧带、半月板、滑膜和膝关节的其他部位1,2。高机械应力很容易导致囊肿的形成，这就是为什么囊肿在膝关节中最常见 3,4，而贝克氏囊肿是最常见的囊肿类型5。膝关节交叉韧带囊肿很少见，在使用膝关节磁共振成像 （MRI） 扫描的病例中，有 0.2%-1.3% 偶然发生，在使用膝关节镜检查检查的患者中，有 0.6% 发生 6,7。后交叉韧带囊肿较为罕见，Brown 和 Dandy 报告说，在对 6,500 名患者进行膝关节镜检查后，他们只发现了 35 个韧带囊肿，只有 6 个来自后交叉韧带5。膝关节韧带囊肿不分性别或年龄均可发生，但在 20 至 40 岁的男性中更常见 4,8。
交叉韧带囊肿的病因尚不清楚。对于膝韧带囊肿的无创诊断，MRI可以清楚地显示囊肿的大小和位置之间的关系，是最准确的诊断方法4,6,9,10。关节镜下切除囊肿是最有效和推荐的治疗方法4,6,9,10。关节镜检查可以直接看到囊肿部位，完全去除囊肿壁，复发率极低，患者手术后恢复迅速7,9,10。后交叉韧带囊肿多呈分叶状或多房性，其中大部分主要位于后交叉韧带后面，在12.5%的患者中，囊肿主要位于后交叉韧带前方11（图1A，B）。
许多治疗方法可用于治疗后交叉韧带囊肿，例如超声和计算机断层扫描引导下的关节穿刺术。然而，几项研究表明，复发的风险可能更高，因此这些手术不会去除囊肿壁12。关节镜下切除囊肿是治疗后交叉韧带囊肿的金标准。关节镜手术可以完全切除囊肿壁，但仅通过前入路很难切除背交叉韧带囊肿。Abreu等人12 介绍了一种使用经鼻中隔门静脉关节镜切除PCL囊肿的方法，该方法安全有效。Tsai等13 报道，经鼻中隔入路切除后交叉韧带囊肿术在15例患者中成功，无复发。经鼻中隔入路需要增加后外侧入路，因此增加了损伤腓总神经和腘神经血管束的风险。为了避免这些风险，我们提出了一种手术方法，通过关节镜双后内侧入路治疗后交叉韧带囊肿。我们的方法不需要额外的后外侧方法;没有损伤腓总神经的风险。我们使用双后内侧入路，将整个手术过程保持在后间隔的内侧，从而减少损伤腘神经血管束的可能性。该技术产生相同的结果，同时比经鼻中隔方法更安全。这种手术方法特别适用于切除位于后交叉韧带背侧的囊肿。如果囊肿分隔或靠近胫骨末端，则手术方法更有利。

<table border="1" fo:keep-together.within-page="1" fo:keep-with-next.within-page="always">
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			<td>Arthroscopic sheath&#160;</td>
			<td>smith&#38;nephew</td>
			<td>72200829</td>
			<td>6mm</td>
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		<tr>
			<td>Arthroscopy</td>
			<td>smith&#38;nephew</td>
			<td>72202087</td>
			<td>30 mm x 4 mm</td>
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			<td>Beam guide&#160;&#160;&#160;&#160;&#160;</td>
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			<td>72204925</td>
			<td>5 mm x 3.6 m</td>
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			<td>Beam guide-arthroscopy end connector&#160;</td>
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			<td>72200315</td>
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			<td>DYONICS POWER II</td>
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			<td>DYONICS POWERMAX ELITE</td>
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			<td>Hook probe&#160;</td>
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			<td>Incisor plus platinum shaver&#160;&#160;&#160;&#160;&#160;</td>
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			<td>Lumbar needle&#160; AN-E/S&#160;<img alt="Equation 1" src="/files/ftp_upload/65620/65620eq01.jpg" style="margin: auto;" /></td>
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			<td>AN-E/S&#160;<img alt="Equation 1" src="/files/ftp_upload/65620/65620eq01.jpg" style="margin: auto;" /></td>
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arthroscopic excision of posterior cruciate ligament cysts using a double posteromedial approach

膝关节交叉韧带囊肿是一种罕见的疾病。膝关节后交叉韧带囊肿比前交叉韧带囊肿少见。对于无症状的孤立性膝关节交叉韧带囊肿患者，建议保守治疗。有症状的膝关节交叉韧带囊肿多表现为膝关节过度屈曲痛、伸直疼痛、长时间站立或行走后出现膝关节不适等，严重影响生活质量，可进行手术治疗。手术治疗可分为超声引导下囊肿穿刺和液体提取手术和关节镜膀胱切除术。囊肿大多呈多层囊肿壁分叶状，囊肿液提取术并不能完全去除囊肿壁，而只是提取囊肿液，导致复发率高。关节镜手术可以完全切除囊肿壁，创伤小，复发率低，术后恢复快，因此关节镜切除术是最常见和首选的治疗方法。由于后交叉韧带囊肿多发生在韧带后方，我们通过在膝关节上增加双后内侧通路来切除囊肿壁，在直视下切除囊肿壁，操作简单，囊肿壁完全清除，创伤小，术后恢复快，无复发。在这里，切除了 8 个后交叉韧带囊肿，术后症状完全缓解，无手术并发症，1 年随访时无复发。

所有八名患者均成功手术，无任何并发症。8例患者中有7例为孤立性后交叉韧带囊肿，1例患者为内侧半月板损伤。所有患者术前的主要症状是膝关节过度屈曲疼痛、无法自由下蹲、长时间站立或长时间行走后膝后部疼痛、不适等。手术后，所有症状均得到缓解并消失（表1）。
7例单纯性后交叉韧带囊肿患者中，术后1年未发现特别不适。术后膝关节活动度较术前明...

Read this Scientific Article Protocol about Author Spotlight: Double Posteromedial Approach for Treating Posterior Cruciate Ligament Cysts at JoVE.com

作者聚焦: 双后内侧入路治疗后交叉韧带囊肿

我们提出了一种通过关节镜双后内侧入路治疗后交叉韧带囊肿的手术方法。

关节镜下使用双后内侧入路切除后交叉韧带囊肿

Cruciate ligament cysts of the knee are a rare condition. Posterior cruciate ligament cysts of the knee are less common than anterior cruciate ligament ...

膝关节交叉韧带囊肿，尤其是后部囊肿，并不常见。关节镜手术是首选的治疗方法，因为创伤最小、复发率低且恢复快。使其成为完全切除囊肿的最常见选择。在关节镜手术中，位于韧带后面的后交叉韧带囊肿采用双后内侧入路治疗。这种方法首先开发了用于完全切除囊肿的视觉方法;简化手术，创伤最小，恢复较少，不会复发。我们的手术方法特别适用于切除位于后交叉韧带背侧的囊肿。如果集合是分隔的或靠近胫骨末端，则第三种方法更有利。

arthroscopic-excision-posterior-cruciate-ligament-cysts-using-double

Research

JoVE Journal

Medicine

Arthroscopic Excision of Posterior Cruciate Ligament Cysts Using a Double Posteromedial Approach

443 次观看.  The Third Hospital of Hebei Medical University. 膝关节交叉韧带囊肿，尤其是后部囊肿，并不常见。关节镜手术是首选的治疗方法，因为创伤最小、复发率低且恢复快。使其成为完全切除囊肿的最常见选择。在关节镜手术中，位于韧带后面的后交叉韧带囊肿采用双后内侧入路治疗。这种方法首先开发了用于完全切除囊肿的视觉方法;简化手术，创伤最小，恢复较少，不会复发。我们的手术方法特别适用于切除位于后交...

视频: 作者聚焦: 双后内侧入路治疗后交叉韧带囊肿

Preparation and Pathogen Inactivation of Double Dose Buffy Coat Platelet Products using the INTERCEPT Blood System

Blood centers are faced with many challenges including maximizing production yield from the blood product donations they receive as well as ensuring the highest possible level of safety for transfusion patients, including protection from transfusion transmitted diseases. This must be accomplished in a fiscally responsible manner which minimizes operating expenses including consumables, equipment, waste, and personnel costs, among others.
Several methods are available to produce platelet concentrates for transfusion. One of the most common is the buffy coat method in which a single therapeutic platelet unit (&ge; 2.0 x1011 platelets per unit or per local regulations) is prepared by pooling the buffy coat layer from up to six whole blood donations. A procedure for producing "double dose" whole blood derived platelets has only recently been developed.
Presented here is a novel method for preparing double dose whole blood derived platelet concentrates from pools of 7 buffy coats and subsequently treating the double dose units with the INTERCEPT Blood System for pathogen inactivation. INTERCEPT was developed to inactivate viruses, bacteria, parasites, and contaminating donor white cells which may be present in donated blood. Pairing INTERCEPT with the double dose buffy coat method by utilizing the INTERCEPT Processing Set with Dual Storage Containers (the "DS set"), allows blood centers to treat each of their double dose units in a single pathogen inactivation processing set, thereby maximizing patient safety while minimizing costs. The double dose buffy coat method requires fewer buffy coats and reduces the use of consumables by up to 50% (e.g. pooling sets, filter sets, platelet additive solution, and sterile connection wafers) compared to preparation and treatment of single dose buffy coat platelet units. Other cost savings include less waste, less equipment maintenance, lower power requirements, reduced personnel time, and lower collection cost compared to the apheresis technique.

This article describes the process used by &#214;rebro University Hospital to produce double dose buffy coat platelet concentrates prepared from whole blood donations and treated with the INTERCEPT Blood System for pathogen inactivation. The in vitro quality of the final platelet units are evaluated over 7 days of storage.

巴菲大衣血小板制品双倍剂量使用INTERCEPT血液系统的制备和病原体灭活

Blood centers are faced with many challenges including maximizing production yield from the blood product donations they receive as well as ensuring the ...

科研

医学

A Possible Zebrafish Model of Polycystic Kidney Disease: Knockdown of wnt5a Causes Cysts in Zebrafish Kidneys

Polycystic kidney disease (PKD) is one of the most common causes of end-stage kidney disease, a devastating disease for which there is no cure. The molecular mechanisms leading to cyst formation in PKD remain somewhat unclear, but many genes are thought to be involved. Wnt5a is a non-canonical glycoprotein that regulates a wide range of developmental processes. Wnt5a works through the planar cell polarity (PCP) pathway that regulates oriented cell division during renal tubular cell elongation. Defects of the PCP pathway have been found to cause kidney cyst formation. Our paper describes a method for developing a zebrafish cystic kidney disease model by knockdown of the wnt5a gene with wnt5a antisense morpholino (MO) oligonucleotides. Tg(wt1b:GFP) transgenic zebrafish were used to visualize kidney structure and kidney cysts following wnt5a knockdown. Two distinct antisense MOs (AUG - and splice-site) were used and both resulted in curly tail down phenotype and cyst formation after wnt5a knockdown. Injection of mouse Wnt5a mRNA, resistant to the MOs due to a difference in primary base pair structure, rescued the abnormal phenotype, demonstrating that the phenotype was not due to &#8220;off-target&#8221; effects of the morpholino. This work supports the validity of using a zebrafish model to study wnt5a function in the kidney.

A Possible Zebrafish Model of Polycystic Kidney Disease: Knockdown of wnt5a Causes Cysts in Zebrafish Kidneys

We describe a method of generating a possible zebrafish model of polycystic kidney disease. We used Tg(wt1b:GFP) fish to visualize kidney structure. Knockdown of wnt5a was by morpholino injection. Pronephric cyst formation after wnt5a knockdown was observed in this GFP transgenic zebrafish.

多囊肾一种可能的斑马鱼型号:击倒<em&gt; Wnt5a的</em&gt;原因在斑马鱼肾囊肿

Polycystic kidney disease (PKD) is one of the most common causes of end-stage kidney disease, a devastating disease for which there is no cure. The ...

Isolation and Excision of Murine Aorta; A Versatile Technique in the Study of Cardiovascular Disease

Cardiovascular disease is a broad term describing disease of the heart and/or blood vessels. The main blood vessel supplying the body with oxygenated blood is the aorta. The aorta may become affected in diseases such as atherosclerosis and aneurysm. Researchers investigating these diseases would benefit from direct observation of the aorta to characterize disease progression as well as to evaluate efficacy of potential therapeutics. The goal of this protocol is to describe proper isolation and excision of the aorta to aid investigators researching cardiovascular disease. Isolation and excision of the aorta allows investigators to look at gross morphometric changes as wells as allowing them to preserve and stain the tissue to look at histologic changes if desired. The aorta may be used for molecular studies to evaluate protein and gene expression to discover targets of interest and mechanisms of action. This technique is superior to imaging modalities as they have inherent limitations in technology and cost. Additionally, primary isolated cells from a freshly isolated and excised aorta can allowing researchers to perform further in situ and in vitro assays. The isolation and excision of the aorta has the limitation of having to sacrifice the animal however, in this case the benefits outweigh the harm as it is the most versatile technique in the study of aortic disease.

Pathology of the aorta can lead to severe morbidity and mortality, therefore research of disease progression and potential therapies is warranted. Here, we present a protocol to isolate and excise the murine aorta to aid researchers in their investigation of cardiovascular disease.

隔离和小鼠主动脉切除;心血管疾病研究的一个多功能的技术

Cardiovascular disease is a broad term describing disease of the heart and/or blood vessels. The main blood vessel supplying the body with oxygenated ...

Localization, Identification, and Excision of Murine Adipose Depots

Obesity has increased dramatically in the last few decades and affects over one third of the adult US population. The economic effect of obesity in 2005 reached a staggering sum of $190.2 billion in direct medical costs alone. Obesity is a major risk factor for a wide host of diseases. Historically, little was known regarding adipose and its major and essential functions in the body. Brown and white adipose are the two main types of adipose but current literature has identified a new type of fat called brite or beige adipose. Research has shown that adipose depots have specific metabolic profiles and certain depots allow for a propensity for obesity and other related disorders. The goal of this protocol is to provide researchers the capacity to identify and excise adipose depots that will allow for the analysis of different factorial effects on adipose; as well as the beneficial or detrimental role adipose plays in disease and overall health. Isolation and excision of adipose depots allows investigators to look at gross morphological changes as well as histological changes. The adipose isolated can also be used for molecular studies to evaluate transcriptional and translational change or for in vitro experimentation to discover targets of interest and mechanisms of action. This technique is superior to other published techniques due to the design allowing for isolation of multiple depots with simplicity and minimal contamination.

Due to the drastic and negative connection between obesity and other comorbidities, research on the role adipose plays in disease and overall health is warranted. We present a protocol for the isolation and excision of adipose depots allowing for the study of adipose using in situ and in vitro methods.

本地化识别，切除脂肪小鼠油库，并

Obesity has increased dramatically in the last few decades and affects over one third of the adult US population. The economic effect of obesity in 2005 ...

Rat Model of Photochemically-Induced Posterior Ischemic Optic Neuropathy

Posterior Ischemic optic neuropathy (PION) is a sight-devastating disease in clinical practice. However, its pathogenesis and natural history have&#160;remained poorly understood. Recently, we developed a reliable, reproducible animal model of PION and tested the treatment effect of some neurotrophic factors in this model1. The purpose of this video is to demonstrate our photochemically induced model of posterior ischemic optic neuropathy, and to evaluate its effects with retrograde labeling of retinal ganglion cells. Following surgical exposure of the posterior optic nerve, a photosensitizing dye, erythrosin B, is intravenously injected and a laser beam is focused onto the optic nerve surface. Photochemical interaction of erythrosin B and the laser during irradiation damages the vascular endothelium, prompting microvascular occlusion mediated by platelet thrombosis and edematous compression. The resulting ischemic injury yields a gradual but pronounced retinal ganglion cell dieback, owing to a loss of axonal input - a remote, injury-induced and clinically relevant outcome. Thus, this model provides a novel platform to study the pathophysiologic course of PION,&#160;and can be further optimized for testing therapeutic approaches for optic neuropathies as well as other CNS ischemic diseases.

The goal of this protocol is to photochemically induce ischemic injury to the posterior optic nerve in rat. This model is critical to studies of the pathophysiology of posterior ischemic optic neuropathy, and therapeutic approaches for this and other optic neuropathies, as well as of other CNS ischemic diseases.

光化学诱导后部缺血性视神经病变的大鼠模型

Posterior Ischemic optic neuropathy (PION) is a sight-devastating disease in clinical practice. However, its pathogenesis and natural history ...

Autologous Microfractured and Purified Adipose Tissue for Arthroscopic Management of Osteochondral Lesions of the Talus

In recent years, regenerative techniques have been increasingly studied and used to treat osteochondral lesions of the talus. In particular, several studies have focused their attention on mesenchymal stem cells derived from adipose tissue. Adipose-derived stem cells (ADSCs) exhibit morphological characteristics and properties similar to other mesenchymal cells, and are able to differentiate into several cellular lines. Moreover, these cells are also widely available in the subcutaneous tissue, representing 10 - 30% of the normal body weight, with a concentration of 5,000 cells per gram of tissue.
In the presented technique, the first step involves harvesting ADSCs from the abdomen and a process of microfracture and purification; next, the surgical procedure is performed entirely arthroscopically, with less soft tissue dissection, better joint visualization, and a faster recovery compared with standard open procedures. Arthroscopy is characterized by a first phase in which the lesion is identified, isolated, and prepared with microperforations; the second step, performed dry, involves injection of adipose tissue at the level of the lesion.
Between January 2016 and September 2016, four patients underwent arthroscopic treatment of osteochondral lesion of the talus with microfractured and purified adipose tissue. All patients reported clinical improvement six months after surgery with no reported complications. Functional scores at the latest follow-up are encouraging and confirm that the technique provides reliable pain relief and improvements in patients with osteochondral lesion of the talus.

The aim of this study is to report a protocol for the arthroscopic treatment of osteochondral lesions of the talus using microfractured and purified adipose-derived stem cells.

自体 Microfractured 与纯化脂肪组织在关节镜下治疗距骨软骨病变

In recent years, regenerative techniques have been increasingly studied and used to treat osteochondral lesions of the talus. In particular, several ...

Posterior Semicircular Canal Approach for Inner Ear Gene Delivery in Neonatal Mouse

Inner ear gene therapy offers great promise as a potential treatment for hearing loss and dizziness. One of the critical determinants of the success of inner ear gene therapy is to find a delivery method which results in consistent transduction efficiency of targeted cell types while minimizing hearing loss. In this study, we describe the posterior semicircular canal approach as a viable method for inner ear gene delivery in neonatal mice. We show that gene delivery through the posterior semicircular canal is able to perfuse the entire inner ear. The easy anatomic identification of the posterior semicircular canal, as well as minimal manipulation of the temporal bone required, make this surgical approach an attractive option for inner ear gene delivery.

In this study, we describe the posterior semicircular canal approach as a reliable method for inner ear gene delivery in neonatal mice. We show that gene delivery through the posterior semicircular canal is able to perfuse the entire inner ear.

后半圆管法在新生小鼠内耳基因传递中的研究

Inner ear gene therapy offers great promise as a potential treatment for hearing loss and dizziness. One of the critical determinants of the success of ...

Vessel-sparing Excision and Primary Anastomosis

Urethroplasty is considered to be the standard treatment for urethral strictures since it provides excellent long-term success rates. For isolated short bulbar or posterior urethral strictures, urethroplasty by excision and primary anastomosis (EPA) is recommended. As EPA only requires the excision of the narrowed segment and the surrounding spongiofibrosis, a full-thickness transection of the corpus spongiosum, as performed in the traditional transecting EPA (tEPA), is usually unnecessary. Jordan et al. introduced the idea of a vessel-sparing approach in 2007, aiming to reduce surgical trauma, especially to the dual arterial blood supply of the urethra, and, thus, potentially reducing the risk of postoperative erectile dysfunction or glans ischemia. This approach could also be beneficial for subsequent urethral interventions such as redo urethroplasty using a free graft, in which a well-vascularized graft bed is imperative. Nevertheless, these potential benefits are only assumptions as prospective studies comparing the functional outcome of both techniques with validated questionnaires are currently lacking. Moreover, vessel-sparing EPA (vsEPA) should at least be able to provide similar surgical outcomes as tEPA. The aim of this paper is to give an elaborate, step-by-step overview of how to manage patients with isolated short bulbar or posterior urethral strictures with vsEPA. The main objective of this manuscript is to outline the surgical technique and to report the representative surgical outcome. A total of 117 patients were managed according to the described protocol. The analysis was performed on the entire patient cohort and on the bulbar (n = 91) and posterior (n = 26) vsEPA group separately. Success rates were 93.4% and 88.5% for the bulbar and posterior vsEPA, respectively. To conclude, vsEPA, as outlined in the protocol, provides excellent success rates with low complication rates for isolated short bulbar and posterior urethral strictures.

Here, we present an elaborate and efficient protocol to treat isolated short bulbar or posterior urethral strictures with vessel-sparing excision and primary anastomosis.

血管保留切除术与原发性吻合术

Urethroplasty is considered to be the standard treatment for urethral strictures since it provides excellent long-term success rates. For isolated short ...

Posterior Approach for Debridement of the Psoas Abscess

This method focuses on outlining a safe zone for irrigation and debridement of a psoas abscess through a posterior approach. Initially, an anterior approach to the spine was performed to ensure that the anterior longitudinal ligament and the psoas muscle could be visualized. All the abdominal organs were removed. Subsequently, a posterior approach was performed to remove the paraspinal muscles from L1&#8211;L5. The transverse processes, pars interarticularis and lamina of L1&#8211;L5 were identified. The exiting nerve root was identified between the transverse processes and followed into the substance of the psoas muscle. Using the anterior and posterior approach, the lumbar plexus was isolated from the substance of the psoas muscle. Before and after various steps of dissection, digital photographs were obtained. These images were uploaded into ImageJ and multiple measurements, including the distance between the lateral superior and inferior tip of each TP to the most lateral region of the plexus, the distance between the lateral superior and inferior tip of the TP to the lateral edge of the psoas, and the width of the lumbar plexus were recorded. The safe zone for entering the substance of the psoas muscle was defined between the lateral edge of the psoas muscle and the lateral edge of the lumbar plexus. The relationship of this interval to the tip of the transverse process at each level was measured and reported.

This is a cadaveric study investigating the landmarks for the posterior approach for irrigation and debridement of the psoas abscess. The interval between the transverse processes (TP) was used to access the substance of the psoas muscle.

切除普索阿脓肿的后向方法

This method focuses on outlining a safe zone for irrigation and debridement of a psoas abscess through a posterior approach. Initially, an anterior ...

Endoscopy Guided Photoablation of Endometrial Cysts using a 980 nm Laser with a Contact Fiber in Mares

In mares, endometrial cysts are associated with endometriosis and can cause maternal recognition failure or compromise and delay pregnancy diagnoses. Historical treatments were invasive and had adverse effects on the endometrium. Hysteroscopically guided laser therapy is easy and effective for endometrial cysts resection, with no deleterious effects for the endometrium.
A 110 cm long and 1.0 cm wide endoscope is sterilely introduced in the uterus through the open cervix of an estrous mare after vulvar cleaning. The uterus is slowly infused with less than 1 L of physiologic solution and the laser fiber is inserted in the biopsy canal of the endoscope. Cysts are then cauterized with the 980 nm diode laser with a contact fiber set at 20&#8210;2 5W in continuous mode. Each cyst is punctured&#160;until complete voiding of the cyst and shrinking of the cyst wall around the fiber. Uterine lavages with sterile saline solution are performed directly after the surgery and for one or two days as non-inflammatory fluid can be observed.
This procedure is easy and quickly performed, with no obvious deleterious effects. Cysts resection makes ultrasound pregnancy diagnosis easier and, in some cases, could restore proper embryo migration in the uterine horns between day 6.5 and 17. However, this treatment does not improve the underlying histological lesions related to endometriosis. These considerations should be clearly expressed to the breeder before this procedure.

The aim of this report is to describe the photoablation of endometrial cysts in the mare using an endoscopic laser device, and to discuss the interest and limitations of this new approach to deal with low fertility issues.

内窥镜引导光活内膜囊肿使用 980 nm 激光与接触纤维在马雷斯

In mares, endometrial cysts are associated with endometriosis and can cause maternal recognition failure or compromise and delay pregnancy diagnoses. ...