Mooney Megan L, Jacobs Cale A, Prusick Vincent W, Riley Scott A
The University of Toledo Medical Center, Toledo, OH.
Shriners Hospitals for Children Medical Center.
J Pediatr Orthop. 2020 Aug;40(7):340-343. doi: 10.1097/BPO.0000000000001517.
Ganglion cysts represent the most common benign soft-tissue masses of the hand and wrist, most are treated nonoperatively, with relatively few local recurrences. Few studies have identified risk factors for recurrence in the pediatric population. The aim of this study is to identify risks of cyst recurrence and to establish if ultrasonographic imaging aids in the prediction of recurrence.
A single-center retrospective chart review was performed, identifying patients diagnosed with a ganglion cyst of the hand or wrist. Demographic information, cyst characteristics, and ultrasound examination reports were documented. Standard statistical and logistic regression analyses were performed.
A total of 132 cysts were identified in 126 patients and the average age was 8.5 years old. The most common location was the dorsal wrist (57/132, 43.2%). There were 14 recurrences [11/14, (79%) dorsal wrist, 3/14 (21%) volar wrist, 0/14 (0%) in nonwrist locations]. The risk of recurrence was significantly greater for dorsal wrist cysts than nonwrist locations (odds ratio=18.1; 95% confidence interval: 1.02, 316.65; P=0.048); there was no statistical difference in recurrence rates between dorsal and volar cysts (P=0.15). Recurrence was noted in older patients (12.2 vs. 8.1 y, P<0.001) and those patients with painful masses (P=0.02). Patients undergoing surgical excision had a higher risk of recurrence than those who did not undergo surgical excision (P<0.001). Cyst volume as measured by ultrasound was performed in 37 cysts, with repeat ultrasounds in 12 cases demonstrating a decreased volume of 0.85 cm at baseline to 0.35 cm with repeat examination (P=0.40). In patients that received at least 1 ultrasound, there were no differences in cyst volume between those that recurred and those that did not (P=0.40).
Risk factors for recurrence in pediatric patients with a ganglion cyst include older age, symptomatic masses, cysts located around the wrist, and those requiring surgical excision. Ultrasound examination of cyst volume did not predict recurrence.
Level III-therapeutic.
腱鞘囊肿是手部和腕部最常见的良性软组织肿块，大多数采用非手术治疗，局部复发相对较少。很少有研究确定儿科人群复发的危险因素。本研究的目的是确定囊肿复发的风险，并确定超声成像是否有助于预测复发。
进行单中心回顾性病历审查，确定诊断为手部或腕部腱鞘囊肿的患者。记录人口统计学信息、囊肿特征和超声检查报告。进行标准统计分析和逻辑回归分析。
126例患者共发现132个囊肿，平均年龄8.5岁。最常见的部位是腕背（57/132，43.2%）。有14例复发[11/14，（79%）腕背，3/14（21%）掌侧腕部，0/14（0%）非腕部位置]。腕背囊肿的复发风险明显高于非腕部位置（比值比=18.1；95%置信区间：1.02，316.65；P=0.048）；掌侧和背侧囊肿的复发率无统计学差异（P=0.15）。年龄较大的患者（12.2岁对8.1岁，P<0.001）和有疼痛肿块的患者（P=0.02）出现复发。接受手术切除的患者比未接受手术切除的患者复发风险更高（P<0.001）。对37个囊肿进行了超声测量囊肿体积，12例重复超声检查显示囊肿体积从基线时的0.85 cm减小到复查时的0.35 cm（P=0.40）。在至少接受1次超声检查的患者中，复发患者和未复发患者的囊肿体积无差异（P=0.40）。
小儿腱鞘囊肿复发的危险因素包括年龄较大、有症状的肿块、位于腕部周围的囊肿以及需要手术切除的囊肿。超声检查囊肿体积不能预测复发。
三级治疗性。
