Department of Orthopaedics, Children's Hospital of Philadelphia, Philadelphia, PA; Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA.
Department of Orthopedics, Nemours/Alfred I. duPont Hospital for Children, Wilmington, DE.
J Hand Surg Am. 2022 Nov;47(11):1119.e1-1119.e8. doi: 10.1016/j.jhsa.2021.09.001. Epub 2021 Oct 11.
Ganglion cysts of the hand/wrist are frequently managed without surgery but can be treated with surgical excision if there is pain or dysfunction. No studies have examined the specific factors predictive of surgical treatment for pediatric patients.
This was a study of pediatric patients (≤18 years) with ganglion cysts of the hand/wrist seen between 2017 and 2019 at 2 institutions. Baseline demographic data were collected in addition to cyst characteristics, Wong-Baker pain scores, and Patient-Reported Outcomes Measurement Information System scores (pain, depression, upper extremity function, anxiety). Multivariable regression was used to determine the factors predictive of surgical intervention at ≥6 months of eligible follow-up.
A total of 167 patients with a mean age of 10.1 ± 5.3 years were included for analysis. Forty-three (25.7%) underwent surgical excision of their ganglion cyst at means of 2.3 months after the initial visit and 12.6 months after cyst appearance. Sex and cyst location were similar between cohorts. Surgical patients were older (12.1 vs 9.4 years, respectively) and presented to the clinic later after an appearance (10.9 vs 6.5 months, respectively) compared to nonsurgical patients. Surgical patients also had higher pain scores at presentation (median, 3 vs 0, respectively). Cysts receiving surgery were larger than those without surgery (81.4% vs 55.3% >1 cm, respectively). Pain interference Patient-Reported Outcomes Measurement Information System scores were higher in the surgical than the nonsurgical group (45.2 vs 39.6, respectively). In a multivariable analysis, pain scores ≥4 (odds ratio, 3.4) were predictive of surgery for patients ≥3 years, whereas older age (odds ratio, 1.1) and a cyst size >1 cm (odds ratio, 3.3) predicted surgery across all patients.
Pediatric patients with ganglion cysts who initially present at older ages with moderate/severe pain scores and larger cysts are more likely to ultimately choose surgical excision. Surgeons may observe a preference for earlier surgery in this subset of patients.
TYPE OF STUDY/LEVEL OF EVIDENCE: Prognostic II.
手部/腕部腱鞘囊肿通常无需手术治疗，但如果存在疼痛或功能障碍，可通过手术切除进行治疗。目前尚无研究探讨可预测小儿患者手术治疗的具体因素。
这是一项对 2017 年至 2019 年在 2 家机构就诊的手部/腕部腱鞘囊肿患儿（≤18 岁）进行的研究。收集了基线人口统计学数据，以及囊肿特征、Wong-Baker 疼痛评分和患者报告的结局测量信息系统评分（疼痛、抑郁、上肢功能、焦虑）。多变量回归用于确定在有资格接受≥6 个月随访的患者中，预测手术干预的因素。
共纳入 167 例患儿，平均年龄为 10.1±5.3 岁。43 例（25.7%）在初始就诊后 2.3 个月、囊肿出现后 12.6 个月行腱鞘囊肿切除术。两组的性别和囊肿位置相似。手术组患者年龄较大（分别为 12.1 岁和 9.4 岁），就诊时间较晚（分别为 10.9 个月和 6.5 个月）。与非手术组相比，手术组患者的初始疼痛评分更高（中位数分别为 3 分和 0 分）。接受手术的囊肿大于未手术的囊肿（分别为 81.4%和 55.3%＞1cm）。疼痛干扰患者报告的结局测量信息系统评分在手术组高于非手术组（分别为 45.2%和 39.6%）。在多变量分析中，年龄≥3 岁的患儿疼痛评分≥4 分（比值比，3.4）是手术的预测因素，而所有患儿中，年龄较大（比值比，1.1）和囊肿＞1cm（比值比，3.3）是手术的预测因素。
手部/腕部腱鞘囊肿的初诊年龄较大、疼痛评分中度/重度、囊肿较大的患儿更可能最终选择手术切除。外科医生可能会观察到这部分患者更倾向于早期手术。
研究类型/证据水平：预后 II 级。
