摘要
目的探讨采用臂丛神经阻滞麻醉下完整切除囊肿,修复腕背关节韧带治疗腕背腱鞘囊肿的临床疗效。方法2005年3月-2007年1月,收治34例腕背腱鞘囊肿。男14例,女20例;年龄25～65岁,平均43岁。左侧22例,右侧12例。13例为术后复发患者,曾于局麻下行1～4次囊肿切除手术,末次术后至复发时间为14d～7年,中位时间17个月;21例为初次手术患者,诊断至手术时间为15d～8年,中位时间11个月。主要症状为腕背胀痛不适和无力。囊肿范围为1.5cm×1.2cm～4.5cm×4.0cm。于臂丛神经阻滞麻醉下,6例囊肿未见明显蒂部结构或蒂部浅在者,完整切除囊肿,术后不限制活动;28例囊肿蒂部累及腕背关节韧带者,囊肿切除后16例直接缝合修复腕背韧带,12例采用伸肌腱鞘管壁或邻近深筋膜组织缝合修复,术后腕关节背伸位外固定3周。结果术后切口均Ⅰ期愈合。患者均获随访,随访时间26～36个月,平均31.5个月。2例分别于术后4个月及1年复发,复发率为5.9%;余患者腕关节活动度正常,腕背症状缓解。末次随访时患者自评满意度评分为60～100分,平均83.8分;其中对腕关节活动度满意度最高(24.6分),对术后切口瘢痕满意度最低(16.7分)。结论臂丛神经阻滞麻醉下,采用从蒂部完整切除囊肿并修复受累腕背韧带,术后外固定3周治疗腕背腱鞘囊肿,复发率低,疗效满意。
Objective To investigate the clinical outcome of treating dorsal wrist ganglion with an improved surgical strategy by excising the ganglion completely along their stalk and repairing the dorsal carpal ligaments under brachial anesthesia.Methods From March 2005 to January 2007,34 patients with dorsal wrist ganglion were treated and studied retrospectively.There were 14 males and 20 females,aged 25-65 years（43 years on average）.The left sides were involved in 22 cases and right sides in 12 cases.Thirteen cases of relapse received excision for 1 to 4 times under local anesthesia,with a mean period of 17 months（14 days to 7 years）from excision to recurrence.Twenty-one patients were first attack cases with a mean period of 11 months（15 days to 8 years）from diagnosis to excision.The size of the ganglion ranged from 1.5 cm× 1.2 cm to 4.5 cm×4.0 cm.Now,each surgical process was performed under brachial anesthesia,and a pneumathode tourniquet was used.In 6 patients,the stalks of ganglion did not invade the carpal ligaments,and ganglion was removed completely without immobilization after operation.In 28 patients,the stalks of ganglion invaded the carpal ligaments,ganglion was excised completely along its stalk to the dorsal carpal structure;the ligaments were sutured directly in 16 cases and were repaired with adjacent tissue such as the wall of sheathing canal of extensor tendon in 12 cases.The wrists were immobilised for 3 weeks.Results Primary wound healing was achieved in all incisions.All patients were followed up for 26-36 months with an average of 31.5 months.Only 2 cases（5.9%）recurred.The range of motion of the wrist remained normal and the symptom of the dorsal wrist was relieved slightly.Patients’satisfaction score ranged from 60 to 100,with an average of 83.8.Conclusion The ganglion should be excised completely together with defect repair of dorsal carpal ligament under brachial anesthesia and the wrist immobilised for 3 weeks,the recurrence rate will be reduced greatly.
出处
《中国修复重建外科杂志》
CAS
CSCD
北大核心
2010年第1期57-59,共3页
Chinese Journal of Reparative and Reconstructive Surgery
关键词
腕背腱鞘囊肿
韧带修复
复发
Dorsal wrist ganglion Ligament repair Recurrence
