Walter Reed National Military Medical Center, Bethesda, MD.
The Children's Hospital of Philadelphia, Philadelphia, PA.
J Hand Surg Am. 2023 Oct;48(10):1018-1024. doi: 10.1016/j.jhsa.2023.07.002. Epub 2023 Aug 18.
This investigation describes the outcomes of pediatric ganglion cysts in a prospective cohort that elected not to undergo cyst aspiration or surgical treatment. Our primary aim was to investigate the rate of spontaneous resolution over time among the subset of patients who did not undergo specific treatments.
Children (aged ≤18 years) who presented to the clinic with ganglion cysts of the hand or wrist were enrolled in a prospective two-center registry between 2017 and 2021. Enrolled subjects who never elected to undergo cyst aspiration or surgical treatment were analyzed. The data collected included age, sex, cyst location and laterality, hand dominance, Wong-Baker pain scale scores, and Patient-Reported Outcome Measurement Information System upper-extremity scores. Follow-up surveys were completed for up to 5 years.
A total of 157 cysts in 154 children, with an average age of 9.4 years and a female-to-male ratio of 1.4:1, were eligible. The most common ganglion location was dorsal wrist (67/157, 42.7%), followed by volar wrist (49/157, 31.2%), the flexor tendon sheath (29/157, 18.5%), and the extensor tendon synovial lining (8/157, 5.1%). The average follow-up duration was 2.5 years after initial presentation to the clinic, and 63.1% (99/157) of the patients responded to follow-up surveys. Among them, 62.6% (62/99) of cysts spontaneously resolved; the resolution rates ranged from 51.9% of volar wrist ganglions to 81% of flexor tendon sheath cysts, with an average time to resolution of 14.1 months after cyst presentation. Cysts were more likely to resolve in the hand than in the wrist (84.0% vs 55.4%, respectively). Cysts present for >12 months at initial evaluation were less likely to resolve spontaneously (41.2% vs 67.1%).
Of children who elected not to undergo aspiration or surgical treatment, approximately two-thirds of families reported that their child's ganglion cyst resolved spontaneously. Cysts that resolve spontaneously usually do so within 2 years of presentation.
TYPE OF STUDY/LEVEL OF EVIDENCE: Therapeutic IV.
本研究描述了一组选择不进行囊肿抽吸或手术治疗的儿科腱鞘囊肿患者的结局。我们的主要目的是调查未接受特定治疗的患者亚组中囊肿自然消退的发生率。
2017 年至 2021 年，在两个中心前瞻性注册登记处招募了手部或腕部腱鞘囊肿就诊的儿童（年龄≤18 岁）。分析从未选择进行囊肿抽吸或手术治疗的入组患者。收集的数据包括年龄、性别、囊肿位置和侧别、手优势、Wong-Baker 疼痛量表评分和患者报告的上肢结局测量信息系统评分。完成了长达 5 年的随访调查。
共有 154 名儿童的 157 个囊肿符合条件，平均年龄为 9.4 岁，男女比例为 1.4:1。最常见的腱鞘囊肿位置是背侧手腕（67/157，42.7%），其次是掌侧手腕（49/157，31.2%）、屈肌腱鞘（29/157，18.5%）和伸肌腱滑膜衬里（8/157，5.1%）。平均随访时间为首次就诊后 2.5 年，63.1%（99/157）的患者接受了随访调查。其中，62.6%（62/99）的囊肿自发消退；消退率范围从掌侧手腕腱鞘囊肿的 51.9%到屈肌腱鞘囊肿的 81%，囊肿出现后平均 14.1 个月消退。手部囊肿比腕部囊肿更易消退（分别为 84.0%和 55.4%）。初次评估时存在超过 12 个月的囊肿自发消退的可能性较小（分别为 41.2%和 67.1%）。
选择不进行抽吸或手术治疗的儿童中，约有三分之二的家庭报告其孩子的腱鞘囊肿自发消退。自发消退的囊肿通常在出现后 2 年内消退。
研究类型/证据水平：治疗性 IV 级。
