Name: arthroscopic excision of posterior cruciate ligament cysts using a double posteromedial approach
Uploaded: 2023-10-20T14:50:00.000+00:00
Duration: 5 min 44 s
Description: Read this Scientific Article Protocol about Author Spotlight: Double Posteromedial Approach for Treating Posterior Cruciate Ligament Cysts at JoVE.com

이 연구는 허베이성 보건부의 청소년 과학 기술 프로젝트의 지원을 받았습니다. (제20201046호).

이 프로토콜은 Hebei Medical University Third Hospital 윤리위원회의 지침을 따릅니다. 이 연구의 일부로 생성된 데이터와 환자를 포함하기 위해 환자로부터 정보에 입각한 동의를 얻었습니다. 이 연구에 등록된 환자는 18세에서 60세 사이였습니다. 이 연구에는 총 8명의 환자가 포함되었는데, 5명의 여성과 3명의 남성이었다.
1. 수술 전 준비
<ol><li>이 연구에 환자를 등록하기 위해 다음 포함 및 제외 기준을 사용하십시오.<ol><li>다음 포함 기준을 사용하십시오: 무릎 MRI로 후방 십자인대 낭종에 대한 명확한 진단을 받은 환자; 후방 십자인대 낭종으로 인해 발생할 수 있는 상당한 무릎 통증, 과신전 통증 및 기타 증상이 있는 환자 또는 관절경 치료가 필요한 복합 반월상 연골 손상이 있는 환자; 삶의 질에 미치는 영향 때문에 수술에 관심이 있는 환자.</li>
		<li>다음 제외 기준을 사용하십시오: 수술을 견딜 수 없는 다른 심각한 의학적 상태가 있는 환자; 외과적 치료를 거부하는 환자; MRI로 진단되었지만 증상이 없는 후방 십자인대 낭종이 있는 환자; 전방십자인대 파열 또는 후방십자인대 파열이 결합된 환자.</li>
	</ol></li>
	<li>모든 환자에게 전신 마취 또는 신경 축성 마취를 사용하십시오. 환자를 수술 침대의 누운 자세로 놓습니다. 허벅지 중앙과 위쪽의 영향을 받는 팔다리에 지혈대를 1시간 이상 적용하지 마십시오. 요오드포어로 환부를 2회 소독하고 수술 시트를 깔아줍니다.</li>
</ol>2. 관절경적 접근법의 확립
<ol><li>혈액 퇴치 벨트를 사용하여 영향을 받은 팔다리에서 혈액을 배출하십시오. 사지 끝에서 근위 끝까지 혈액 퇴치 벨트를 조입니다. 각 랩이 1/3씩 겹치도록 합니다. 각 회전 사이에 연조직을 삽입하지 마십시오. 수술한 팔다리의 연조직에서 피를 빼냅니다. 50kPa 압력/힘을 가하여 지혈대를 팽창시킵니다.</li>
	<li>외측 무릎 라인에서 1cm, 슬개건 가장자리에서 1cm 측면으로 전방 접근법을 설정합니다. 11G의 날카로운 칼날을 사용하여 피부에서 관절강까지 약 0.5cm 크기로 절개합니다.</li>
	<li>내측 무릎 관절선에서 1cm 위, 슬개건 가장자리에서 내측 1cm의 전방 내측 접근법을 확립합니다. 11G의 날카로운 칼날을 사용하여 피부에서 관절강까지 약 0.5cm 크기로 절개합니다.</li>
	<li>관절경을 경골 플랫폼과 평행하게 삽입하여 각각 내측 및 외측 접근 방식으로 intercondylar fossa를 향합니다. 슬개상낭, 슬개대퇴 관절, 내측 반월상 동맥 청소, 외측 대변구 고랑, 전방 십자인대, 후방 십자인대, 내측 반월상 연골 및 외측 반월상 연골을 탐색합니다.</li>
	<li>부상당한 반월상 연골을 부분적으로 제거하거나 부상당한 반월상 연골을 봉합합니다. 관절이 없는 본체를 제거합니다. 관절 내의 모든 부상을 치료하십시오.</li>
	<li>아래 설명된 대로 정상적인 후방 접근법을 설정합니다.<ol><li>무릎을 90°로 구부립니다. 전내측 접근법에 관절경을 삽입하여 intercondylar fossa를 모니터링하고 전측 접근법에 스위칭 로드를 배치합니다.</li>
		<li>후방 십자인대(PCL)와 내측 대퇴 과두 사이의 교환 막대를 관절경 감시 하에 후관절낭에 삽입합니다. 일반적으로 들어오고 빠져나가는 뚜렷한 느낌이 있습니다.</li>
		<li>렌즈를 내측 후방 관절낭으로 회전시킵니다. 관절낭(joint capsule), 내측 대퇴 과두(medial femoral condyle), 내측 반월상 연골(medial meniscus)의 역습에 의해 형성된 삼각형 영역을 보십시오.</li>
		<li>수술실 조명을 끕니다. 무릎 후방 내측 피부 표면의 반투명 영역을 관찰합니다(그림 2).</li>
		<li>요추 바늘을 사용하여 위치를 잡는 데 도움을 줍니다(그림 3). 반투명 영역(보통 대퇴골 후과두 뒤쪽 0.5-1cm 및 관절선에 근접)의 관절낭에 편심 천자.</li>
		<li>11G의 날카로운 칼날을 사용하여 피부를 0.5cm 정도 작게 절개합니다. 직선 cl을 삽입하십시오.amp 관절경 감시 하에 관절 캡슐에 넣습니다. 정상적인 후방 접근법을 확립합니다.</li>
	</ol></li>
	<li>아래에 설명된 대로 높은 후방 접근 방식을 설정합니다.<ol><li>관절경 검사를 후측 접근법에 삽입합니다. 요추 바늘을 관절 방향으로 삽입하고 후측근에서 2-3cm 근접하게 삽입합니다.</li>
		<li>요추 바늘이 내측 후방 과두, 내측 반월상 연골 및 후방 관절낭의 삼각형 공간에서 관절낭으로 관통하도록 합니다.</li>
		<li>피부를 작게 절개합니다. 직선 cl을 삽입하십시오.amp 관절경 감시 하에 관절 캡슐에 넣습니다. 높은 후방 접근법을 확립합니다.</li>
	</ol></li>
</ol>3. 후방 십자인대 낭종의 노출 및 제거
<ol><li>관절경 검사를 고도 후방 접근법으로 삽입합니다. 면도기를 정상적인 후방 접근 방식으로 삽입합니다(그림 4).</li>
	<li>면도기를 사용하여 후방 십자인대와 관절낭 사이의 활막 조직을 제거합니다.</li>
	<li>후방 십자인대 주위의 반투명하고 융기된 활막인 낭종을 찾습니다(그림 1C). 낭종 벽을 제거하고 낭종 벽에서 노란색과 반투명 액체가 흘러나오는 것을 보고 낭종의 구획과 같은 조직을 시각화합니다.</li>
	<li>후방 낭종 벽을 완전히 제거하십시오. 후방 십자인대와 후방 혈관 및 신경의 손상을 피하고 부상 없이 후방 십자인대를 탐색합니다.</li>
	<li>전외측 접근법에 관절경 검사를 삽입합니다. 후방 십자인대의 대퇴골 말단에 있는 낭종의 일부를 보십시오.</li>
	<li>전방 낭종 벽을 제거하고 낭종 벽에서 노란색과 반투명 액체가 흘러나오는 것을 볼 수 있습니다. 낭종 벽을 완전히 제거하십시오.</li>
	<li>전방십자인대와 후방십자인대 사이의 V자형 공간에서 활막 조직을 제거합니다. 후방 십자인대를 조사하고 후방 십자인대의 손상 여부를 확인합니다.</li>
	<li>내측 슬개골 접근법에 관절경을 삽입합니다. 전방십자인대와 후방십자인대 사이의 V자형 공간에 잔류 낭종이 있는지 확인합니다.</li>
	<li>관절경 검사를 posteromedial approach에 삽입합니다. 잔류 낭종이 있는지 확인하십시오.</li>
</ol>4. 절개 부위의 봉합
<ol><li>전외측 접근법에 관절경 덮개를 삽입합니다. 슬개상낭을 짜내고 관절 내 액체를 완전히 배출합니다. 무릎 신전과 굴곡 활동을 0°에서 120°까지 확인하십시오.</li>
	<li>절개 부위를 명주사 4호로 봉합합니다.</li>
</ol>5. 수술 후 재활
<ol><li>대퇴사두근 운동: 환자에게 누운 자세에서 이 운동을 하도록 요청합니다. 영향을 받은 다리를 곧게 펴고 발가락을 걸고 다리를 발뒤꿈치 약 15cm 높이까지 천천히 들어 올리고 3초 동안 유지한 다음 천천히 내립니다.</li>
	<li>관절 이완 훈련: 환자가 침대 옆에 앉아서 무릎 관절을 스스로 펴고 구부리면서 이 훈련을 수행하도록 요청합니다.</li>
	<li>수술 후 2일째 되는 날에 환자에게 침대에서 일어나 적절하게 움직이고 점차 정상적인 활동으로 돌아갈 것을 요청합니다.</li>
	<li>수술 후 3일마다 드레싱을 교체하고 수술 후 14일째 되는 날에 실밥을 제거합니다.</li>
	<li>수술 후 첫 달에는 조깅과 같은 비대면 활동을 하고 수술 후 세 번째 달에는 정상적인 활동을 재개하도록 환자에게 요청합니다.</li>
</ol>6. 수술 후 관리 및 후속 조치
<ol><li>수술 후 6시간 동안 베개 없이 반듯하게 누워 있도록 환자에게 요청하십시오. 환자는 약 3일 동안 입원했습니다.</li>
	<li>수술 후 3개월이 지나면 환자의 운동 범위가 정상으로 돌아오는지 확인하고 수술 후 12개월이 지나면 영향을 받은 무릎에 MRI 검사와 관절경 검사를 병행하여 환부에 불편함이 있는지, 낭종이 재발했는지 확인합니다.</li>
</ol>

PCL 낭종 절제술을 위한 관절경 이중 후방 접근법

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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>

저자들은 이 연구에서 이해 상충이 없다고 선언합니다.

후방 십자인대 낭종은 희귀 질환입니다. 무릎 인대 낭종은 일반적으로 MRI 또는 무릎 관절경 검사에서 발견됩니다. 무릎 인대 낭종 형성의 원인은 외상 후 형성, 배아 형성 중 활막 조직 탈장 형성, 중간엽 줄기 세포 증식 및 형성 등 다양합니다. 최근에는 외상 및 조직 자극술이 대부분의 전문가들에 의해 인정되고 있다 2,7,14.</p...

관절낭종은 낭포성 병변이며, 낭종액은 인대, 반월상 연골, 활막, 무릎 관절의 다른 부분에서 찾을 수 있는 투명한 젤리 모양의 액체입니다 1,2. 높은 기계적 스트레스는 쉽게 낭종을 형성할 수 있기 때문에 낭종은 무릎 관절에서 가장 흔하며3,4 베이커 낭종은 가장 흔한 유형의 낭종이다5. 무릎의 십자인대 낭종은 드물며, 무릎 자기 공명 영상(MRI)을 사용하여 스캔한 사례의 0.2%에서 1.3%에서 우연히 발생하며, 무릎 관절경 검사를 사용하여 검사한 환자의 0.6%에서 발생합니다 6,7. 후방십자인대 낭종은 더 드물며, Brown과 Dandy는 6,500명의 환자에게 무릎 관절경 검사를 실시한 후 35개의 인대 낭종과 후방 십자인대5에서 6개의 종만 발견되었다고 보고했습니다. 무릎 인대 낭종은 성별이나 연령에 관계없이 발생할 수 있지만 20세에서 40세 사이의 남성에서 더 흔하다 4,8.
십자인대 낭종의 원인은 알려져 있지 않습니다. 무릎 인대 낭종의 비침습적 진단을 위해 MRI는 낭종의 크기와 위치 간의 관계를 명확하게 보여줄 수 있으며 가장 정확한 진단 방법입니다 4,6,9,10. 낭종의 관절경 제거는 가장 효과적이고 권장되는 치료 방법입니다 4,6,9,10. 관절경 검사는 낭종 부위를 직접 볼 수 있고 낭종 벽을 완전히 제거할 수 있으며 재발률이 매우 낮고 수술 후 환자가 빠르게 회복됩니다 7,9,10. 후방십자인대 낭종은 대부분 소엽 또는 다발성으로 나타나며, 대부분은 주로 후방십자인대 뒤쪽에 위치하며, 12.5%의 환자에서 낭종은 주로 후방십자인대 전방에 위치한다11(그림 1A,B).
후방 십자인대 낭종을 치료하기 위해 초음파와 컴퓨터 단층 촬영 유도 관절 천자와 같은 많은 치료법이 사용될 수 있습니다. 그러나, 몇몇 연구들은 잠재적으로 재발의 위험이 더 높다는 것을 보여주었는데, 그 이유는 이러한 시술들이 낭종 벽을 제거하지 않기 때문이다12. 낭종의 관절경 제거는 후방 십자인대 낭종 치료의 황금 표준입니다. 관절경 수술은 낭종 벽을 완전히 제거할 수 있지만 전방 접근법만으로 등쪽 십자인대 낭종을 제거하기는 어렵습니다. Abreu et al.12 는 경중격 포털을 사용하여 PCL 낭종의 관절경 절제에 대한 접근법을 소개했으며, 이는 안전하고 효과적입니다. Tsai et al.13 은 후방 십자인대 낭종 절제에 대한 경중격 접근법이 15명의 환자에서 성공적이었고 재발이 없었다고 보고했습니다. 경중격 접근법은 후외측 접근법을 추가해야 하므로 총비골 신경과 슬금 신경혈관 다발이 손상될 위험이 증가합니다. 이러한 위험을 피하기 위해 관절경 이중 후방 접근법으로 후방 십자인대 낭종을 치료하는 수술적 접근법을 제시합니다. 우리의 접근 방식은 추가적인 후방 접근 방식을 필요로 하지 않습니다. 총비골 신경을 손상시킬 위험이 없습니다. 우리는 이중 후방 접근법을 사용하는데, 이는 전체 수술 과정을 후방 중격의 내측에 유지하여 슬랭탈 신경혈관 다발의 손상 가능성을 줄입니다. 이 기술은 경중격 접근법보다 안전하면서도 동일한 결과를 생성합니다. 이 수술적 접근법은 후방 십자인대의 등쪽에 위치한 낭종을 제거하는 데 특히 적합합니다. 수술적 접근법은 낭종이 구획화되어 있거나 경골 끝에 가까운 경우에 더 유리합니다.

<table><tbody><tr><td>Arthroscopic sheath&amp;nbsp;</td><td>smith&amp;amp;nephew</td><td>72200829</td><td>6mm</td></tr><tr><td>Arthroscopy</td><td>smith&amp;amp;nephew</td><td>72202087</td><td>30 mm x 4 mm</td></tr><tr><td>Beam guide&amp;nbsp;&amp;nbsp;&amp;nbsp;&amp;nbsp;&amp;nbsp;</td><td>smith&amp;amp;nephew</td><td>72204925</td><td>5 mm x 3.6 m</td></tr><tr><td>Beam guide-arthroscopy end connector&amp;nbsp;</td><td>smith&amp;amp;nephew</td><td>2143</td><td></td></tr><tr><td>Beam guide-panel connector&amp;nbsp;&amp;nbsp;</td><td>smith&amp;amp;nephew</td><td>2147</td><td></td></tr><tr><td>Blood-repellent belt</td><td>selani</td><td>tpe15100</td><td>15 cm x 1 m</td></tr><tr><td>Blunt puncture cone&amp;nbsp;&amp;nbsp;</td><td>smith&amp;amp;nephew</td><td>4356</td><td>4 mm</td></tr><tr><td>Camera&amp;nbsp;&amp;nbsp;&amp;nbsp;&amp;nbsp;&amp;nbsp;</td><td>smith&amp;amp;nephew</td><td>72200561</td><td>NTSC/PAL</td></tr><tr><td>Coupler&amp;nbsp;&amp;nbsp;</td><td>smith&amp;amp;nephew</td><td>72200315</td><td></td></tr><tr><td>DYONICS POWER II</td><td>smith&amp;amp;nephew</td><td>72200873</td><td>100-24VAC, 50/60Hz</td></tr><tr><td>DYONICS POWERMAX ELITE</td><td>smith&amp;amp;nephew</td><td>72200616</td><td></td></tr><tr><td>Endoscopic camera system</td><td>smith&amp;amp;nephew</td><td>72201919</td><td>560P NTSC/PAL</td></tr><tr><td>HD monitor&amp;nbsp;</td><td>smith&amp;amp;nephew</td><td>&amp;nbsp;LB500031</td><td>27 inch&amp;nbsp;</td></tr><tr><td>Hook probe&amp;nbsp;</td><td>smith&amp;amp;nephew</td><td>3312</td><td></td></tr><tr><td>Incisor plus platinum shaver&amp;nbsp;&amp;nbsp;&amp;nbsp;&amp;nbsp;&amp;nbsp;</td><td>smith&amp;amp;nephew</td><td>72202531</td><td>&amp;nbsp;4.5 mm</td></tr><tr><td>Lumbar needle&amp;nbsp; AN-E/S&amp;nbsp;&lt;img alt=&quot;Equation 1&quot; src=&quot;/files/ftp_upload/65620/65620eq01.jpg&quot; style=&quot;margin: auto;&quot;/&gt;</td><td>tuoren</td><td>AN-E/S&amp;nbsp;&lt;img alt=&quot;Equation 1&quot; src=&quot;/files/ftp_upload/65620/65620eq01.jpg&quot; style=&quot;margin: auto;&quot;/&gt;</td><td>1.6 mm x 80 mm</td></tr><tr><td>Micropunch,teardrop,left&amp;nbsp;&amp;nbsp;</td><td>smith&amp;amp;nephew</td><td>7207602</td><td></td></tr><tr><td>Micropunch,teardrop,right&amp;nbsp;</td><td>smith&amp;amp;nephew</td><td>7207601</td><td></td></tr><tr><td>Micropunch,teardrop,straight&amp;nbsp;</td><td>smith&amp;amp;nephew</td><td>7207600</td><td></td></tr><tr><td>Pitbull Jr. Grasper&amp;nbsp;&amp;nbsp;</td><td>smith&amp;amp;nephew</td><td>14845</td><td></td></tr></tbody></table>

arthroscopic excision of posterior cruciate ligament cysts using a double posteromedial approach

무릎의 십자인대 낭종은 드문 질환입니다. 무릎의 후방 십자인대 낭종은 전방 십자인대 낭종보다 덜 흔합니다. 무증상 무릎 고립성 십자인대 낭종이 있는 환자에서는 보존적 치료가 권장됩니다. 무릎의 증상적 십자인대 낭종은 대부분 무릎 과굴곡 통증, 곧게 펴지는 통증, 장시간 서 있거나 오래 걸었을 때 무릎 불편감 등으로 나타나 삶의 질에 심각한 영향을 미치므로 수술적 치료를 시행할 수 있습니다. 수술적 치료는 초음파 유도 낭종 천자 및 체액 추출 시술과 관절경 방광 절제술로 나눌 수 있습니다. 낭종은 대부분 다층 낭종 벽으로 형성되며, 낭종액 추출은 낭종 벽을 완전히 제거하지 않고 단순히 낭종액을 추출하는 방식으로 낭종액을 추출하기 때문에 재발률이 높습니다. 관절경 수술은 외상이 적고 재발률이 낮으며 수술 후 회복이 빠르며 낭종 벽을 완전히 제거할 수 있으므로 관절경 절제술이 가장 일반적이고 선호되는 치료 방법입니다. 후방십자인대 낭종은 대부분 인대 후방에서 발생하기 때문에 무릎 관절에 이중 후방 접근법을 추가하여 낭종벽을 제거하고 낭종벽을 직접 시야로 제거하여 조작이 간편하고 낭종벽이 완전히 제거되며 외상이 작고 수술 후 회복이 빠르며 재발이 없습니다. 여기에서 8개의 후방 십자인대 낭종을 제거했으며 수술 후 증상이 완전히 완화되고 수술 합병증이 없었으며 1년 추적 관찰에서 재발이 없었습니다.

8명의 환자 모두 합병증 없이 성공적으로 수술을 받았습니다. 8명의 환자 중 7명은 고립된 후방 십자인대 낭종이었고, 1명은 내측 반월상 연골 손상이 있었다. 수술 전 모든 환자의 주요 증상은 무릎 굴곡 과잉 통증, 자유롭게 쪼그리고 앉을 수 없음, 통증, 장시간 서 있거나 오래 걸었을 때 무릎 뒤쪽의 불편함입니다. 수술 후 모든 증상이 완화되고 사라졌다(표 1).
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Read this Scientific Article Protocol about Author Spotlight: Double Posteromedial Approach for Treating Posterior Cruciate Ligament Cysts at JoVE.com

저자 스포트라이트: 후방 십자인대 낭종 치료를 위한 이중 후방 접근법

후방 십자인대 낭종을 치료하기 위한 관절경 이중 후방 접근법을 통한 수술적 접근법을 제시합니다.

Double posteromedial Approach를 사용한 후방 십자인대 낭종의 관절경 절제

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

십자인대 무릎 낭종, 특히 후방 낭종은 흔하지 않습니다. 관절경 수술은 외상이 적고 재발이 적으며 회복이 빠르기 때문에 선호되는 치료법입니다. 완전한 낭종 제거를 위한 가장 일반적인 선택입니다.인대 뒤에 위치한 후방 십자인대 낭종은 관절경 수술 시 이중 후방 접근법으로 치료합니다. 이 접근법은 처음으로 완전한 낭종 제거를 위해 시각적으로 개발되었습니다. 최소한의 외상, 더 적은 회복 및 재발 없이 절차를 단순화합니다. 우리의 수술적 접근법은 후방 십자인대의 등쪽에 위치한 낭종을 제거하는 데 특히 적합합니다.세 번째 접근 방식은 세트가 구획화되어 있거나 경골 끝에 가까운 경우 더 유리합니다.

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Medicine

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

467 조회수.  The Third Hospital of Hebei Medical University. 십자인대 무릎 낭종, 특히 후방 낭종은 흔하지 않습니다. 관절경 수술은 외상이 적고 재발이 적으며 회복이 빠르기 때문에 선호되는 치료법입니다. 완전한 낭종 제거를 위한 가장 일반적인 선택입니다.인대 뒤에 위치한 후방 십자인대 낭종은 관절경 수술 시 이중 후방 접근법으로 치료합니다. 이 접근법은 처음으로 완전한 낭종 제거를 위해 시각적으로 개발되었습니다....

비디오: 저자 스포트라이트: 후방 십자인대 낭종 치료를 위한 이중 후방 접근법

A Simplified Technique for In situ Excision of Cornea and Evisceration of Retinal Tissue from Human Ocular Globe

Enucleation is the process of retrieving the ocular globe from a cadaveric donor leaving the rest of the globe undisturbed. Excision refers to the retrieval of ocular tissues, especially cornea, by cutting it separate from the ocular globe. Evisceration is the process of removing the internal organs referred here as retina. The ocular globe consists of the cornea, the sclera, the vitreous body, the lens, the iris, the retina, the choroid, muscles etc (Suppl. Figure 1). When a patient is suffering from corneal damage, the cornea needs to be removed and a healthy one must be transplanted by keratoplastic surgeries. Genetic disorders or defects in retinal function can compromise vision. Human ocular globes can be used for various surgical procedures such as eye banking, transplantation of human cornea or sclera and research on ocular tissues. However, there is little information available on human corneal and retinal excision, probably due to the limited accessibility to human tissues. Most of the studies describing similar procedures are performed on animal models. Research scientists rely on the availability of properly dissected and well-conserved ocular tissues in order to extend the knowledge on human eye development, homeostasis and function. As we receive high amount of ocular globes out of which approximately 40% (Table 1) of them are used for research purposes, we are able to perform huge amount of experiments on these tissues, defining techniques to excise and preserve them regularly.
The cornea is an avascular tissue which enables the transmission of light onto the retina and for this purpose should always maintain a good degree of transparency. Within the cornea, the limbus region, which is a reservoir of the stem cells, helps the reconstruction of epithelial cells and restricts the overgrowth of the conjunctiva maintaining corneal transparency and clarity. The size and thickness of the cornea are critical for clear vision, as changes in either of them could lead to distracted, unclear vision. The cornea comprises of 5 layers; a) epithelium, b) Bowman's layer, c) stroma, d) Descemet's membrane and e) endothelium. All layers should function properly to ensure clear vision4,5,6. The choroid is the intermediate tunic between the sclera and retina, bounded on the interior by the Bruch's membrane and is responsible for blood flow in the eye. The choroid also helps to regulate the temperature and supplies nourishment to the outer layers of the retina5,6. The retina is a layer of nervous tissue that covers the back of the ocular globe (Suppl. Figure 1) and consists of two parts: a photoreceptive part and a non-receptive part. The retina helps to receive the light from the cornea and lens and converts it into the chemical energy eventually transmitted to the brain with help of the optic nerve5,6.
The aim of this paper is to provide a protocol for the dissection of corneal and retinal tissues from human ocular globes. Avoiding cross-contamination with adjacent tissues and preserving RNA integrity is of fundamental importance as such tissues are indispensable for research purposes aimed at (i) characterizing the transcriptome of the ocular tissues, (ii) isolating stem cells for regenerative medicine projects, and (iii) evaluating histological differences between tissues from normal/affected subjects. In this paper we describe the technique we currently use to remove the cornea, the choroid and retinal tissues from an ocular globe. Here we provide a detailed protocol for the dissection of the human ocular globe and the excision of corneal and retinal tissues. The accompanying video will help researchers to learn an appropriate technique for the retrieval of precious human tissues which are difficult to find regularly.

A Simplified Technique for In situ Excision of Cornea and Evisceration of Retinal Tissue from Human Ocular Globe

The paper describes a simplified technique to excise corneal and to eviscerate retinal tissues from the ocular globe of human cadaveric donors. The technique described here will help to excise good quality tissues to be used for transplantation, surgical or research purposes without damaging other tissues of the ocular globe.

위한 간편한 기법<em&gt; 현장에서</em인간 안구 글로브에서 각막 및 망막 조직의 내장 적출의&gt; 절단

Enucleation is the process of retrieving the ocular globe from a cadaveric donor leaving the rest of the globe undisturbed. Excision refers to the ...

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의학

Surgical Retrieval, Isolation and In vitro Expansion of Human Anterior Cruciate Ligament-derived Cells for Tissue Engineering Applications

Injury to the ACL is a commonly encountered problem in active individuals. Even partial tears of this intra-articular knee ligament lead to biomechanical deficiencies that impair function and stability. Current options for the treatment of partial ACL tears range from nonoperative, conservative management to multiple surgical options, such as: thermal modification, single-bundle repair, complete reconstruction, and reconstruction of the damaged portion of the native ligament. Few studies, if any, have demonstrated any single method for management to be consistently superior, and in many cases patients continue to demonstrate persistent instability and other comorbidities.
The goal of this study is to identify a potential cell source for utilization in the development of a tissue engineered patch that could be implemented in the repair of a partially torn ACL. A novel protocol was developed for the expansion of cells derived from patients undergoing ACL reconstruction. To isolate the cells, minced hACL tissue obtained during ACL reconstruction was digested in a Collagenase solution. Expansion was performed using DMEM/F12 medium supplemented with 10% fetal bovine serum (FBS) and 1% penicillin/streptomycin (P/S). The cells were then stored at -80 &#186;C or in liquid nitrogen in a freezing medium consisting of DMSO, FBS and the expansion medium. After thawing, the hACL derived cells were then seeded onto a tissue engineered scaffold, PLAGA (Poly lactic-co-glycolic acid) and control Tissue culture polystyrene (TCPS). After 7 days, SEM was performed to compare cellular adhesion to the PLAGA versus the control TCPS. Cellular morphology was evaluated using immunofluorescence staining. SEM (Scanning Electron Microscope) micrographs demonstrated that cells grew and adhered on both PLAGA and TCPS surfaces and were confluent over the entire surfaces by day 7. Immunofluorescence staining showed normal, non-stressed morphological patterns on both surfaces. This technique is promising for applications in ACL regeneration and reconstruction.

Surgical Retrieval, Isolation and In vitro Expansion of Human Anterior Cruciate Ligament-derived Cells for Tissue Engineering Applications

For future applications as a patch to repair partial tears of the Anterior Cruciate Ligament (ACL), human ACL derived cells were isolated from tissue obtained during reconstructive procedures, expanded in vitro and grown on tissue engineered scaffolds. Cellular adhesion and morphology was then performed to confirm biocompatibility on scaffold surface.

외과 검색, 분리 및<em&gt; 체외</em&gt; 조직 공학 응용 프로그램에 대한 인간의 전방 십자 인대에서 파생 된 세포의 확장

Injury to the ACL is a commonly encountered problem in active individuals. Even partial tears of this intra-articular knee ligament lead to biomechanical ...

생체공학

Athymic Rat Model for Evaluation of Engineered Anterior Cruciate Ligament Grafts

Anterior cruciate ligament (ACL) rupture is a common ligamentous injury that often requires surgery because the ACL does not heal well without intervention. Current treatment strategies include ligament reconstruction with either autograft or allograft, which each have their associated limitations. Thus, there is interest in designing a tissue-engineered graft for use in ACL reconstruction. We describe the fabrication of an electrospun polymer graft for use in ACL tissue engineering. This polycaprolactone graft is biocompatible, biodegradable, porous, and is comprised of aligned fibers. Because an animal model is necessary to evaluate such a graft, this paper describes an intra-articular athymic rat model of ACL reconstruction that can be used to evaluate engineered grafts, including those seeded with xenogeneic cells. Representative histology and biomechanical testing results at 16 weeks postoperatively are presented, with grafts tested immediately post-implantation and contralateral native ACLs serving as controls. The present study provides a reproducible animal model with which to evaluate tissue engineered ACL grafts, and demonstrates the potential of a regenerative medicine approach to treatment of ACL rupture.

Animal models are important tools for the evaluation of tissue-engineered grafts. This paper presents the protocol for preparing an electrospun biodegradable polymer graft for use in anterior cruciate ligament tissue engineering, as well as a surgical protocol for implantation in a rat model.

엔지니어링 전방 십자 인대 이식의 평가 흉선 쥐 모델

Anterior cruciate ligament (ACL) rupture is a common ligamentous injury that often requires surgery because the ACL does not heal well without ...

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.

다낭성 신장 질환의 가능한 제브라 피쉬 모델 :의 넉다운<em&gt; wnt5a</em&gt; Zebrafish의 신장의 낭종 원인

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.

분리 및 설치류 대동맥 절제; 심혈관 질환의 연구에 다목적 기술

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.

현지화, 식별 및 절제 쥣과 지방이 종점의

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 ...

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.

헌 Microfractured 고 순화 된 지방 조직에서 탈 러 스의 Osteochondral 장애의 절경 관리에 대 한

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

An Effective Surgical Strategy for Anteromedial Osteoarthritis of the Knee with Simultaneous Popliteal Cysts Drainage

Unicompartmental knee arthroplasty (UKA) is an established treatment option for anteromedial osteoarthritis, and popliteal cysts are a common finding in the knee among patients with chronic osteoarthritis pain. The two are so closely related that popliteal cysts are commonly discovered during the unicompartmental knee arthroplasty preoperative examination. However, only a few reports exist on the management and outcome of popliteal cysts in the patients receiving UKA for knee osteoarthritis (OA) and popliteal cysts. As such, it is crucial to evaluate different treatment strategies and their management of popliteal cysts. In this paper, we evaluate a surgical strategy for patients with knee anteromedial osteoarthritis and symptomatic popliteal cysts. These patients were treated with UKA and internal drainage of the popliteal cyst. The results shown here, spanning 1-year post-operation follow-up, demonstrated that UKA and internal drainage is an effective surgical protocol for treating anteromedial osteoarthritis with symptomatic popliteal cysts.

Popliteal cysts are frequently found during the pre-operative examination of patients with osteoarthritis being prepared for the unicompartmental knee arthroplasty. These symptomatic cysts usually require treatment. To do this, a unicompartmental knee arthroplasty was performed with internal drainage of the popliteal cyst under the same anesthetic.

Unicompartmental knee arthroplasty (UKA) is an established treatment option for anteromedial osteoarthritis, and popliteal cysts are a common finding in ...

Arthroscopic Repair of Medial Meniscus Posterior Root Tear with Adjustable Titanium Plate Fixation

Medial meniscus injury is one of the most prevalent knee disorders, with posterior root tears occurring in approximately 10% to 21% of affected individuals. A posterior root tear disrupts the meniscus's continuous annular structure, compromising its ability to absorb pressure and protect the knee's articular cartilage. If left untreated, this can result in increased stress on the cartilage, leading to conditions such as varus deformity and accelerated joint degeneration. Partial removal (resection) of the medial meniscus further exacerbates these issues, often leading to quicker joint deterioration. Repairing medial meniscus posterior root tears (MMPRTs) plays a crucial role in restoring the meniscus's structural integrity and improving knee biomechanics. Studies have shown that compared to partial medial meniscectomy or conservative treatments, repairing MMPRTs enhances clinical outcomes and significantly delays the onset of arthritis. This article details a surgical procedure that uses a single-suture, double-loop, adjustable titanium plate fixation technique under arthroscopy for effective MMPRT repair.

This article describes a surgical approach to repairing a medial meniscus posterior root tear (MMPRT) using a single-suture, double-loop, adjustable titanium plate internal fixation under arthroscopy.

Double posteromedial Approach를 사용한 후방 십자인대 낭종의 관절경 절제

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