de Villiers C M, Birnie R H, Pretorius L K, Vlok G J
Department of Orthopaedic Surgery, University of Stellenbosch, Tygerberg Hospital, Parowvallei, CP.
S Afr Med J. 1989 Mar 4;75(5):214-6.
It is shown that the dorsal ganglion arises as a herniation from the dorsal scapholunate ligament. This herniation increases in size (according to La Place's law) owing to the unidirectional pinchcock effect of the mucosal folds of the duct and the pressure of the overlying extensor retinaculum until the distending pressure inside the ganglion equals the overlying tissue pressure. Wrist gangliography, retrograde wrist arthrography, histology and nuclear magnetic resonance were used to prove this conclusively. Bearing the pathogenesis in mind, the best clinical results were obtained by excision of the ganglion with 0.5 cm2 of dorsal scapholunate ligament and closure of the dorsal capsule with a 3/0 Vicryl purse-string suture. Non-surgical sclerotherapy led to severe inflammation and sepsis and a recurrence rate of 45%. Conservative therapy is illogical since the communicating duct remains and synovial fluid from the scapholunate joint will cause a reherniation and recurrence of the ganglion.
结果表明，背侧腱鞘囊肿是由舟月背侧韧带的疝出形成的。由于腱鞘黏膜皱襞的单向夹闭效应以及上方伸肌支持带的压力，根据拉普拉斯定律，这种疝出会逐渐增大，直至腱鞘内的扩张压力等于上方组织压力。腕关节腱鞘造影、逆行腕关节造影、组织学检查及核磁共振检查均确凿地证实了这一点。考虑到其发病机制，切除腱鞘囊肿并连带切除0.5平方厘米的舟月背侧韧带，然后用3/0薇乔缝线连续缝合背侧关节囊，可获得最佳临床效果。非手术硬化疗法会导致严重炎症和脓毒症，复发率为45%。保守治疗不合理，因为连通管道依然存在，舟月关节的滑液会导致腱鞘再次疝出和复发。
