超声引导下微创治疗手腕部腱鞘囊肿  

Ultrasound-guided minimally-invasive treatment for hand and wrist ganglions

作　　者：范慧慧[1] 徐华军[1] 李雄峰[2] 施林枫[1] FAN Huihui;XU Huajun;LI Xiongfeng;SHI Linfeng(Department of Ultrasound,Huzhou Municipal Central Hospital,Affiliated Central Hospital of Huzhou Normal College,Huzhou,Zhejiang Province 313003,China)

机构地区：[1]湖州市中心医院/湖州师范学院附属中心医院超声科,浙江313003 [2]湖州市中心医院/湖州师范学院附属中心医院骨科,浙江313003

出　　处：《介入放射学杂志》2021年第1期39-42,共4页Journal of Interventional Radiology

基　　金：浙江省湖州市公益性技术应用研究计划项目(2018GYB68、2017GYB25)。

摘　　要：目的探讨超声引导下囊壁多点粗针切割开窗术联合类固醇注射治疗手腕部腱鞘囊肿的应用价值。方法选取经超声和骨科确诊的171例手腕部腱鞘囊肿随机分配入单纯抽液组(n=42)、抽液联合粗针切割组(n=62)和粗针切割联合类固醇组(n=67),依据不同方法进行治疗,治疗后6个月随访复查评估治疗有效率,对治疗后有效组与无效组两组间临床及超声特征进行比较分析。结果手腕部腱鞘囊肿42例单纯抽液组治疗有效20例(47.6%),62例抽液联合粗针切割组治疗有效42例(67.7%),67例粗针切割联合类固醇组治疗有效56例(83.6%),三组间疗效差异有显著统计学意义(χ^(2)=15.68,P<0.001),进一步组与组之间两两比较显示粗针切割联合类固醇组治疗有效率高于单纯抽液组和抽液联合粗针切割组(P<0.05);与治疗有效组相比,无效组囊肿以1~3 cm和>3 cm为主(49例),囊腔常伴分隔、囊肿多位于掌侧且与关节腔相通(P<0.05)。结论超声引导下微创治疗手腕部腱鞘囊肿安全、可靠,囊壁多点粗针切割开窗联合类固醇注射可提高手腕部腱鞘囊肿治疗有效率,降低复发风险。Objective To discuss the application value of ultrasound-guided thick-needle multiplepoint cutting fenestration on cystic wall technique combined with steroid injection in treating hand and wrist ganglions. Methods A total of 171 patients with ultrasound and orthopaedics confirmed hand and wrist ganglions were randomly divided into simple liquid-aspiration group(group A,n=42),liquid-aspiration combined thick-needle multiple-point cutting fenestration group(group B,n=62),and thick-needle multiple-point cutting fenestration on cystic wall technique combined with steroid injection group(group C,n=67). The patients of each group received corresponding therapeutic scheme. Six months after treatment,the patients received follow-up reexamination and the therapeutic effect rate was evaluated,and the clinical manifestations and ultrasound features were compared between the valid group and invalid group. Results The clinical effect of cure in group A,group B and group C was obtained in 20 patients(20/42,47.6%),42 patients(42/62,67.7%) and 56 patients(56/67,83.6%),respectively,the differences between each other among the three groups were statistically significant(χ^(2)=15.68,P<0.001). The clinical effect rate of group C was remarkably higher than that of group A and group B(P<0.05). Compared with the valid group,in the invalid group the diameter of most cysts was within 1-3 cm or even≥3 cm(n=49),and usually there were septa in cyst cavity and most of the cysts were located on the palmar side of the wrist and communicated with the articular cavity(P<0.05). Conclusion For the treatment of hand and wrist tenon sheath cysts,ultrasound-guided minimally-invasive treatment is clinically safe and reliable. Ultrasound-guided thick-needle multiple-point cutting fenestration on cystic wall technique combined with steroid injection can improve the effective rate for hand and wrist ganglions and reduce the risk of recurrence.(J Intervent Radiol,2021,30: 39-42)

关 键 词：腱鞘囊肿 超声引导 类固醇 开窗术 复发 

分 类 号：R714[医药卫生—妇产科学]