Chung Sze-Ryn, Tay Shian Chao
1 Department of Hand Surgery, Singapore General Hospital, Singapore.
Hand Surg. 2015 Oct;20(3):415-20. doi: 10.1142/S0218810415500331.
The purpose of this study is to audit the clinical and functional outcomes of arthroscopic ganglionectomy (AG) in our centre.
A retrospective study was conducted on all 29 patients who underwent AG from 2007 to 2012 with a mean clinic and telephone follow-up duration of 6 months and 32 months respectively.
A total of 29 patients (17 women and 12 men) with a mean age of 38 years underwent AG. 15 patients (52%) had associated pain with the lump, 24 out of 29 patients (83%) had preoperative ultrasound to confirm the diagnosis. All patients had preoperative wrist radiographs that showed no chronic carpal instability and bony pathology. 26 out of 29 patients (90%) had dorsal wrist ganglions and 3 patients (10%) had volar wrist ganglions. 15 out of 24 ganglions (62.5%) were multiloculated. Mean ganglion size clinically and through wrist ultrasound was 2.5 cm and 1.8 cm respectively. During arthroscopy, ganglion stalk was identified in 14 patients (48%). Average operating time was 69.5 minutes. Intraoperatively, 24 out of 29 patients (83%) had wrist synovitis and 26 patients (90%) had associated carpal ligament laxity. 97% of cases were successfully resected arthroscopically. Recurrence rate was 10% (3 cases). There was no significant difference between preoperative and postoperative range of motion of wrists - the mean wrist flexion ranged from 63 to 59 degrees pre and postoperatively, and the mean wrist extension ranged from 66 to 64 degrees pre and postoperatively. Overall grip strength improved from 27 kg to 32 kg ([Formula: see text]), and there was also a significant improvement in pain scores pre and post-operatively from visual analogue scale (VAS) score of 0.8 to 0.3 ([Formula: see text]). No major intra or post-operative complications occurred. All patients were satisfied in terms of cosmesis.
AG is a safe and reliable alternative to open resection of wrist ganglions. In addition, it can be used as a diagnostic and therapeutic tool for other wrist conditions.
本研究旨在评估我院关节镜下腱鞘囊肿切除术（AG）的临床及功能疗效。
对2007年至2012年期间接受AG手术的29例患者进行回顾性研究，平均门诊随访时间和电话随访时间分别为6个月和32个月。
共有29例患者（17例女性，12例男性）接受了AG手术，平均年龄38岁。15例患者（52%）伴有肿块疼痛，29例患者中有24例（83%）术前行超声检查以明确诊断。所有患者术前行腕部X线检查，均未显示慢性腕关节不稳定和骨质病变。29例患者中有26例（90%）为腕背侧腱鞘囊肿，3例（10%）为腕掌侧腱鞘囊肿。24个腱鞘囊肿中有15个（62.5%）为多房性。腱鞘囊肿临床及腕部超声测量的平均大小分别为2.5 cm和1.8 cm。关节镜检查时，14例患者（48%）发现腱鞘囊肿蒂。平均手术时间为69.5分钟。术中，29例患者中有24例（83%）存在腕部滑膜炎，26例患者（90%）伴有腕部韧带松弛。97%的病例通过关节镜成功切除。复发率为10%（3例）。术前和术后腕关节活动范围无显著差异——术前和术后腕关节平均屈曲角度分别为63度至59度，平均伸展角度分别为66度至64度。总体握力从27 kg提高到32 kg（[公式：见原文]），术前和术后疼痛评分也有显著改善，视觉模拟评分（VAS）从0.8降至0.3（[公式：见原文]）。未发生重大术中或术后并发症。所有患者对美容效果均满意。
AG是开放性腕部腱鞘囊肿切除术的一种安全可靠的替代方法。此外，它还可作为其他腕部疾病的诊断和治疗工具。
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