腕关节镜治疗腕背侧腱鞘囊肿  

Wrist Arthroscopy in the Treatment of Carpal Dorsal Ganglion

作　　者：舒正华[1] 李钧[1] 丁潮琪[1] 王西迅[1] 陈波[1] 胡继超[1] 魏勇[1] 崔岩[1] 

机构地区：[1]武警浙江省总队医院骨三科,嘉兴314000

出　　处：《中国微创外科杂志》2015年第3期248-250,268,共4页Chinese Journal of Minimally Invasive Surgery

摘　　要：目的探讨关节镜治疗腕背侧腱鞘囊肿的临床价值。方法 2009年9月-2013年5月,治疗22例腕背侧腱鞘囊肿。分别以4/5或6R入路作为关节镜视野,1/2入路为工作通路,6U作为出水通道,找到舟月韧带后并向背侧检查,直至舟月韧带与桡腕背侧关节囊的折反部位,显露腕背侧腱鞘囊肿的蒂部,确认后使用刨刀刨除囊肿蒂部以及部分关节囊,挤压并吸除囊液直至囊肿消失,可吸收线缝合皮下,加压包扎,术后支具固定腕关节3周,并辅助以囊肿部位按摩、腕关节功能锻炼。结果 2例术中关节镜检查未发现囊肿蒂部而转为开放手术,发现其中1例囊肿起源于伸肌腱,1例起源于腕中关节。20例镜下完成,随访6-14个月,平均9.2月,腕关节无明显瘢痕,外形美观,功能无影响。3例复发,其中1例复发囊肿较为细小,腕关节中立位时外观不明显,未作进一步处理,2例行开放手术切除。结论关节镜治疗腕背侧腱鞘囊肿虽然有相对较高的器械以及技术要求,且适应证有一定的局限,但该手术安全,并发症少,外形美观,对于一些外形要求较高的年轻女性可作为治疗方法的选择。Objective To investigate the clinical value of arthroscopy in the treatment of dorsal carpal ganglion. Methods A total of 22 cases of dorsal carpal ganglion was treated from September 2009 to May 2013. With 4 /5 or 6R portal access as arthroscopy vision,1 /2 portal access as working pathway,and 6U for outflow,the scapholunate interosseous ligament（ SLIL） was found and then the examination was carried out toward dorsal part till the reentry point of SLIL and dorsal carpal articular capsule.Pedicles of dorsal carpal ganglion were exposed,and the pedicles and part of articular capsules were removed by planer tools. The joint fluid was cleaned till the ganglion disappeared. Then absorbable sutures were used to close subcutaneous tissues. Pressure bandaging was given. After the operation,a supporter was used to fix the wrist for 3 weeks,during which massage and restorative exercise were conducted. Results Conversion to open surgery was required in 2 cases because the pedicles of dorsal carpal ganglion were not found in intraoperative arthroscopic examinations,including the cyst originated in the extensor tendon in 1 case and originated in the mediocarpal joint in 1 case. The remaining 20 cases underwent treatment under arthroscopy successfully. The patients were followed up for 6- 14 months,with an average of 9. 2 months. The wrists were normal in appearance and fully functional without obvious scars.Three cases developed recurrence,1 of which was not given further intervention because the cyst was too tiny to be found at neutral position,and 2 of which were given open resections. Conclusions Although arthroscopic treatment of dorsal carpal ganglion has a relatively high equipment and technical requirements and has certain limitations on indications, the surgery is safe with few complications and good appearance. It can be used as a treatment option for some young women with strong cosmetic requirements.

关 键 词：腕关节镜 腕背侧腱鞘囊肿 舟月韧带 

分 类 号：R687.2[医药卫生—骨科学]