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腕部腱鞘囊肿切除术后的复发、再次手术及患者报告的结局

Recurrence, Reoperation, and Patient-Reported Outcomes after Wrist Ganglion Excision.

作者信息

Lans Jonathan, George Keith M, Hazewinkel Merel, Eberlin Kyle R, Chen Neal C, Garg Rohit

机构信息

Department of Orthopaedic Surgery, Hand and Upper Extremity Service, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts.

Division of Plastic and Reconstructive Surgery, Massachusetts General Hospital, Harvard Medical School. Boston, Massachusetts.

出版信息

J Wrist Surg. 2023 Oct 9;13(5):439-445. doi: 10.1055/s-0043-1775999. eCollection 2024 Oct.

Abstract

Ganglion excision is performed for pain, functional impairment, or cosmetic reasons, with recurrence rates ranging between 9 and 20%. The aim of this study was to evaluate the recurrence and reoperation rates after ganglion excision, along with assessing patient-reported outcomes.  Retrospectively, 1,076 patients, with 1,080 wrist ganglia, were identified who underwent open excision (  = 1,055) and arthroscopic excision (  = 25). The ganglia were predominantly dorsal (59%) and volar (37%). Additionally, 149 patients who underwent open excision and all who underwent arthroscopic excision were contacted to complete a questionnaire on recurrence and reoperation, the Quick Disabilities of the Arm, Shoulder, and Hand (QuickDASH), and the Patient-Rated Wrist Evaluation (PRWE). Seventy-seven patients responded at a median of 4 years postoperatively. A matched case-control analysis was performed to identify factors associated with reoperation, along with a bivariate analysis to assess what factors influence patient-reported outcomes.  The reoperation rate was 3.3%, with no factors statistically associated with reoperation in case-control analysis. Among the contacted patients, 13% reported a recurrence, of which 2.6% reported reoperation. The median QuickDASH score was 2.3 (interquartile range [IQR]: 0-12), the median PRWE score was 0 (IQR: 0-12), and the median pain score was 0 (IQR: 0-3), with female sex being associated with higher scores.  The reoperation rate after ganglion excision is low (3.3%) and is mostly performed within 3 years. The self-reported ganglion recurrence is higher (13%), but only one-fifth of these patients reported a repeat excision. After surgery, patients report good functional scores, with little persistent pain.

摘要

腱鞘囊肿切除术用于缓解疼痛、改善功能障碍或出于美容目的,其复发率在9%至20%之间。本研究的目的是评估腱鞘囊肿切除术后的复发率和再次手术率,并评估患者报告的结局。回顾性分析了1076例患者,共1080个腕部腱鞘囊肿,其中1055例行开放性切除术,25例行关节镜下切除术。腱鞘囊肿主要位于背侧(59%)和掌侧(37%)。此外,我们联系了149例行开放性切除术的患者以及所有行关节镜下切除术的患者,让他们完成一份关于复发和再次手术、手臂、肩部和手部快速残疾评估量表(QuickDASH)以及患者自评腕关节评估量表(PRWE)的问卷。77例患者进行了回复,术后中位时间为4年。进行了匹配病例对照分析以确定与再次手术相关的因素,并进行双变量分析以评估哪些因素会影响患者报告的结局。再次手术率为3.3%,病例对照分析中没有发现与再次手术有统计学关联的因素。在回复问卷的患者中,13%报告复发,其中2.6%报告再次手术。QuickDASH评分中位数为2.3(四分位间距[IQR]:0 - 12),PRWE评分中位数为0(IQR:0 - 12),疼痛评分中位数为0(IQR:0 - 3),女性患者得分较高。腱鞘囊肿切除术后的再次手术率较低(3.3%),且大多在3年内进行。自我报告的腱鞘囊肿复发率较高(13%),但这些患者中只有五分之一报告再次切除。术后患者报告功能评分良好,持续性疼痛较少。

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