囊肿病灶旷置术治疗指复发性黏液囊肿  

Cyst lesion exclusion surgery for treatment of recurrent

作　　者：张清林[1] 晋栋栋 荣存敏[1] 栗威[1] 张磊[2] 韩清銮[1] Zhang Qinglin;Jin Dongdong;Rong Cunmin;Li Wei;Zhang Lei;Han Qingluan(Department of Hand and Foot Surgery,Afiliated Hospital of Jining Medical University,Jining 272000,China;General Surgery Teaching and Research Ofice,Clinical Cllege of Jining Medical University,Jining 272067,China)

机构地区：[1]济宁医学院附属医院手足外科,济宁272029 [2]济宁医学院临床学院外总教研室,济宁272067

出　　处：《中华手外科杂志》2023年第5期446-449,共4页Chinese Journal of Hand Surgery

基　　金：山东省中医药科技发展项目(2019-0470);济宁市重点研发计划项目(2022YXNS062、2022YXNS047)。

摘　　要：目的分析评价指间关节清理、骨赘切除、囊肿病灶旷置术治疗复发性指黏液囊肿的临床疗效。方法我院自2016年1月至2020年2月收治复发性指黏液囊肿患者21例, 其中针刺抽吸注射类固醇激素后复发3例, 囊肿切除加局部植皮修复术后复发5例, 单纯囊肿切除术后复发13例。均采用臂丛神经阻滞麻醉下指间关节清理、骨赘切除、囊肿病灶旷置术治疗, 仅保留指间关节双侧的侧副韧带及指伸肌腱, 术后患指伸直位夹板固定3周。随访观察术后切口愈合及黏液囊肿复发情况, 对比术前术后指间关节疼痛视觉模拟评分(visual analogue score, VAS)及手指指间关节活动度(range of motion, ROM)。结果 21例患者术后切口均愈合良好, 无感染、无皮肤坏死, 囊肿无复发。所有患者术后随访18~24个月, 平均(21.0±1.9)个月, 末次随访指间关节疼痛VAS评分(1.93±0.46)分较术前(3.07±0.83)分显著降低, 差异有统计学意义(P<0.05);指间关节ROM术后(70.29±7.05)°较术前(69.60±5.40)°无明显变化, 差异无统计学意义(P>0.05)。结论采用指间关节清理、骨赘切除、囊肿病灶旷置术治疗指复发性黏液囊肿, 可避免囊肿切除引起的皮肤坏死及囊肿复发, 是一种安全有效的治疗方法。Objective To analyze and evaluate the clinical efficacy of interphalangeal joint clearance,osteophyte resection,and cyst lesion exclusion surgery in the treatment of recurrent finger mucocele.Methods From January 2016 to February 2020,21 patients with recurrent finger mucocele were treated in our hospital.Among them,3 cases recurred after needle aspiration and injection of steroid hormones,5 cases recurred after cyst resection and local skin grafting repair,and 13 cases recurred after simple cyst resection.All patients were treated with interphalangeal joint clearance,osteophyte resection,and cyst lesion exclusion under brachial plexus block anesthesia.Only the collateral ligaments and extensor tendons on both sides of the interphalangeal joint were preserved,and the affected finger was fixed with a splint in the extension position for 3 weeks after surgery.The postoperative wound healing and recurrence of mucocele were followed up and observed,and the visual analog score(VAS)and range of motion(ROM)of interphalangeal joint were compared before and after surgery.Results All 21 patients had good postoperative incision healing.No infection,skin necrosis,and recurrence of cysts occurred.All patients were follow-up for 18 to 24 months,with an average of(21.0±1.9)months.The VAS of interphalangeal joint at the last follow-up(1.93±0.46)was significantly lower than that before surgery(3.07±0.83),and the difference was statistically significant(P<0.05).There was no significant change in the postoperative ROM(70.29±7.05)°of interphalangeal joint compared to preoperative ROM(69.60±5.40)°,and the difference was not statistically significant(P>0.05).Conclusion nThe application of interphalangeal joint clearance,osteophyte resection,and cyst lesion exclusion surgery to treat recurrent mucocele of the finger can avoid skin necrosis and cyst recurrence caused by cyst resection,and is a safe and effective treatment method.

关 键 词：黏液囊肿 治疗结果 指间关节 骨赘切除 关节清理术 

分 类 号：R687.3[医药卫生—骨科学]