Die arthroskopische Resektion dorsaler Handgelenksganglien

 

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Zusammenfassung

Im Rahmen arthroskopischer Behandlungsmöglichkeiten des Handgelenks hat sich mittlerweile auch die Resektion dorsaler Handgelenksganglien etabliert. Als Vorteile der arthroskopischen Ganglionresektion gegenüber dem offenen Vorgehen werden die Minimalinvasivität mit niedriger Komplikationsrate und eine niedrige Morbidität mit geringen postoperativen Schmerzen, frühzeitiger Mobilisierung und damit verbundener geringerer postoperativer Bewegungseinschränkung sowie eine kürzere Arbeitsunfähigkeitsdauer diskutiert. Als weiterer Vorteil wird die Möglichkeit der Beurteilung begleitender Gelenkpathologien gesehen. Hinsichtlich der Rezidivrate scheint sich heute abzuzeichnen, dass sie bei arthroskopischem und offenem Vorgehen gleich ist. Die Identifizierung eines sogenannten Ganglionstiels scheint nicht die Bedeutung zu haben, die ihr bisher beigemessen wurde. Diskutiert wird vorrangig die Lage und Größe des anzulegenden Kapselfensters und die Notwendigkeit der mediokarpalen Arthroskopie zusätzlich zur radiokarpalen. Uneinigkeit besteht hinsichtlich der Erfolgsaussichten bei der Behandlung von Rezidivganglien. Die eigenen Erfahrungen und die einiger anderer Autoren sind hierzu aber positiv. In der Literatur finden sich kaum Angaben zur Behandlung okkulter dorsaler Handgelenksganglien, die aber aus Sicht der Autoren sehr wohl als möglich und auch erfolgreich einzuschätzen ist.

Abstract

In arthroscopic wrist surgery, the resection of dorsal wrist ganglia has become a well accepted practice. As advantages for the minimally inva­sive procedure the low complication rate and low postoperative morbidity, less postoperative pain and faster recovery over open techniques are discussed. The possibility to assess accompanying joint pathology is considered as another advantage. The importance of identifying a so-called ganglion cyst stalk seems to have been overstated. Regarding the technique, the main discussion points are the size and localisation of the capsular window and the necessity of addi­tional midcarpal arthroscopy. The possibility and results of treatment of recurrent ganglion cysts are still controversial. Our own experience and that of some authors are positive. Hardly men­tioned in the literature is the treatment of occult dorsal wrist ganglia and its results, which is considered as very successful by the authors.

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