支具外固定预防腕部腱鞘囊肿开放手术后复发的效果观察

doi:10.3760/cma.j.cn101202-20190902-00273

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摘要目的观察支具外固定预防腕部腱鞘囊肿切除术后复发的临床效果。方法前瞻性研究。纳入江苏省南通市第四人民医院骨科2010年1月—2015年12月40例腕部腱鞘囊肿患者的临床资料,男13例、女27例,年龄19~63岁。按照治疗方式不同分为两组:对照组20例,单纯予以囊肿完整切除及韧带关节囊修复;观察组20例,在对照组处理的基础上,以支具外固定于腕背伸20°~30°的腕关节功能位,支具远端固定至2~5掌骨远端、近端固定至前臂中段, 指间关节及掌指关节需每日主动屈伸活动。随访观察患者手术后的伤口愈合情况、术后并发症、腕关节功能及术后3年腱鞘囊肿的复发情况。采用Cooney腕关节评估量表评价并比较两组患者术前及术后6个月腕关节功能。结果术中发现,本组40例患者中,14例腱鞘囊肿的蒂部起源于伸指肌腱腱膜下方的破损处, 26例蒂部起源于腕关节韧带或者关节囊的破损处。观察组和对照组患者的性别、年龄、病程、囊肿位置等差异均无统计学意义(P值均＞0.05);患者术后切口均一期愈合,无感染及皮肤坏死;术后6个月腕关节功能均较术前改善,差异均有统计学意义(Z_观察组=-3.755、Z_对照组=-2.449, P值均＜0.05),且观察组优于对照组(Z=-2.678, P＜0.01)。术后随访3年,观察组无复发病例,而对照组有6例腱鞘囊肿复发。结论腕部腱鞘囊肿患者在完整切除囊肿和腕部韧带修复的基础上,采用支具外固定处理,能有效地预防腱鞘囊肿的复发,短期效果满意,值得临床推广应用。

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	丁正美
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关键词 ：骨囊肿, 腱鞘囊肿, 腕关节, 外固定器, 外科手术, 复发

Key words： Bone cysts Ganglion cysts Carpal joints External fixators Surgical procedures,operation Recrudescence

收稿日期: 2019-09-02

通讯作者: 曹建华, Email: nt_dzm@sina.com

引用本文:

丁正美, 朱小建, 曹建华, 陶永清, 秦晓东. 支具外固定预防腕部腱鞘囊肿开放手术后复发的效果观察[J]. 中华解剖与临床杂志, 2020, 25(5): 565-568.
Ding Zhengmei, Zhu Xiaojian, Cao Jianhua, Tao Yongqing, Qin Xiaodong. Observation on the effect of external fixation on preventing recurrence of wrist ganglion cyst after open operation. Chinese Journal of Anatomy and Clinics, 2020, 25(5): 565-568.

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http://www.cjac.com.cn/CN/10.3760/cma.j.cn101202-20190902-00273 或 http://www.cjac.com.cn/CN/Y2020/V25/I5/565

[1]	舒正华, 李钧, 丁潮琪, 等. 腕关节镜治疗腕背侧腱鞘囊肿[J]. 中国微创外科杂志, 2015, (3): 248-250, 268. DOI:10.3969/j.issn.1009-6604.2015.03.015.Shu ZH, Li Z, Ding CQ, et al. Wrist arthroscopy in the treatment of carpal dorsal ganglion[J]. Chinese Journal of Minimally Invasive Surgery, 2015, (3): 248-250, 268. DOI:10.3969/j.issn.1009-6604.2015.03.015.
[2]	Ho PC, Lo WN, Hung LK. Arthroscopic resection of volar ganglion of the wrist: a new technique[J]. Arthroscopy, 2003, 19(2): 218-221. DOI:10.1053/jars.2003.50035.
[3]	王海华, 胡琪, 张长清, 等. 腕背腱鞘囊肿的手术方法改进和临床应用[J]. 中国修复重建外科杂志, 2010, 24(1): 57-59. Wang HH, Hu Q, Zhang CQ, et al. An improved surgical strategy and treatment outcome of dorsal wrist ganglion[J]. Chinese Journal of Reparative and Reconstructive Surgery, 2010, 24(1): 57-59.
[4]	Cooney WP, Bussey R, Dobyns JH, et al. Difficult wrist fractures. Perilunate fracture-dislocations of the wrist[J]. Clin Orthop Relat Res, 1987, (214): 136-147.
[5]	el-Noueam KI, Schweitzer ME, Blasbalg R, et al. Is a subset of wrist ganglia the sequela of internal derangements of the wrist joint? MR imaging findings[J]. Radiology, 1999, 212(2): 537-540. DOI:10.1148/radiology.212.2.r99au34537.
[6]	Gude W, Morelli V. Ganglion cysts of the wrist: pathophysiology, clinical picture, and management[J]. Curr Rev Musculoskelet Med, 2008, 1(3-4): 205-211. DOI:10.1007/s12178-008-9033-4.
[7]	de Villiers CM, Birnie RH, Pretorius LK, et al. Dorsal ganglion of the wrist—pathogenesis and biomechanics. Operative v. conservative treatment[J]. S Afr Med J, 1989, 75(5): 214-216.
[8]	Tophoj K, Henriques U. Ganglion of the wrist—a structure developed from the joint. A histological study with serial sections[J]. Acta Orthop Scand, 1971, 42(3): 244-250. DOI:10.3109/17453677108989043.
[9]	Edwards SG, Johansen JA. Prospective outcomes and associations of wrist ganglion cysts resected arthroscopically[J]. J Hand Surg Am, 2009, 34(3): 395-400. DOI:10.1016/j.jhsa.2008.11.025.
[10]	邱永敏, 顾兴初. 手部腱鞘囊肿459例手术治疗分析[J]. 中国骨伤, 1998, 11(6): 19-19. DOI:10.3969/j.issn.1003-0034.1998.06.008.
[11]	何嘉辉, 彭水清. 腕部腱鞘囊肿抽吸注药与手术切除对比分析[J]. 岭南现代临床外科, 2015, 15(6): 737-739. DOI:10.3969/j.issn.1009-976X.2015.06.024.He JH, Peng SQ. Comparative analysis of aspiration plus injection and excision in treatment of the wrist ganglion[J]. Lingnan Modern Clinics in Surgery, 2015, 15(6): 737-739. DOI:10.3969/j.issn.1009-976X.2015.06.024.
[12]	柴益铜, 滕晓峰, 王欣, 等. 腕关节镜辅助下治疗腕部腱鞘囊肿的体会[J]. 全科医学临床与教育, 2015, 13(6): 680-681. DOI:10.13558/j.cnki.issn1672-3686.2015.06.025.
[13]	刘波. 腕关节损伤治疗相关争议问题探讨[J]. 中华创伤杂志, 2018, 34(9): 769-772. DOI:10.3760/cma.j.issn.1001-8050.2018.09.001.
[14]	Richman JA, Gelberman RH, Engber WD, et al. Ganglions of the wrist and digits: results of treatment by aspiration and cyst wall puncture[J]. J Hand Surg Am, 1987, 12(6): 1041-1043. DOI:10.1016/s0363-5023(87)80108-9.
[15]	孙洋, 周齐娜, 赵鸿. 隐性腕背腱鞘囊肿6例的诊治[J]. 广东医学, 2012, 33(16): 2375. DOI:10.3969/j.issn.1001-9448.2012.16.004.
[16]	邓军荣, 向龙京, 陈振兵. 舟骨月骨间韧带损伤修复早期效果[J]. 中国修复重建外科杂志, 2010, 24(11): 1401-1402.
[17]	陈振兵, 洪光祥, 王发斌. 骨锚治疗舟骨月骨间韧带损伤[J]. 中华创伤杂志, 2007, 23(8): 590-592. DOI:10.3760/j.issn:1001-8050.2007.08.011.Chen ZB, Hong GX, Wang FB. Effects of bone anchors on treatment of scapholunatum interosseous ligament injury[J]. Chin J Trauma, 2007, 23(8): 590-592. DOI:10.3760/j.issn:1001-8050.2007.08.011.
[18]	梅国华, 范存义, 柴益民, 等. 复位内固定联合腕骨间韧带修补治疗急性经舟月骨或月骨周围脱位[J]. 中华手外科杂志, 2010, 26(3): 175-178. DOI:10.3760/cma.j.issn.1005-054X.2010.03.021.Mei GH, Fan CY, Cai YM, et al. Open reduction and internal fixation combined with intercarpal ligament repair for the treatment of acute perilunate transscaphoid fracture dislocations of perilunate dislocations[J]. Chin J Hand Surg, 2010, 26(3): 175-178. DOI:10.3760/cma.j.issn.1005-054X.2010.03.021.
[19]	常青, 黄迅悟, 关长勇, 等. 应用Herbert螺钉内固定治疗腕舟骨骨折[J]. 中华手外科杂志, 2002, 18(4): 217-218. DOI:10.3760/cma.j.issn.1005-054X.2002.04.009.Chang Q, Huang XW, Guan CY, et al. Treatment of carpal scaphoid fracture by internal fixation with Herbert screw[J]. Chin J Hand Surg, 2002, 18(4): 217-218. DOI:10.3760/cma.j.issn.1005-054X.2002.04.009.
[20]	江长青, 肖颖锋, 张耀华, 等. 腕关节镜辅助下修复舟月韧带治疗腕关节不稳定[J]. 实用手外科杂志, 2011. 25(4): 298-300. DOI:10.3969/j.issn.1671-2722.2011.04.016.
[21]	Inoue G, Shionoya K, Kuwahata Y. Herbert screw fixation for scaphoid nonunions. An analysis of factors influencing outcome[J]. Clinical Orthopaedics and Related Research, 1997(343): 99-106. DOI:10.1097/00003086-199710000-00019.
[22]	郭巨灵.临床骨科学(骨病)[M]. 北京:人民卫生出版社,1990:517.
[23]	徐静, 汤锦波, 范辉, 等. 腕尺桡偏运动时腕韧带长度变化的活体研究[J].中华骨科杂志, 2010, 30(9): 887-891. DOI:10.3760/cma.j.issn.0253-2352.2010.09.012. Xu J, Tang JB, Fan H, et al. Changes in lengths of the wrist ligaments during wrist radioulnar deviation: an in vivo study[J]. Chin J Orthop, 2010, 30(9): 887-891. DOI:10.3760/cma.j.issn.0253-2352.2010.09.012.