事件记录
面试官: So if you've been on social media lately and follow any of those pimple popper videos or whatever, 你可能听说过神经节囊肿. It is a small bump that usually shows up on the hands or the joints. And online, they'll tell you to pierce it with a needle or hit it with a big old book. We're going to find out if that's the right way to treat these big old cysts.
今天和大发娱乐一起的是博士. 布拉德·罗克韦尔. He is a professor of plastic surgery and he works with hands.
现在,博士. 洛克威尔，说到神经节囊肿，它是什么?
Dr. 罗克韦尔: 所有 of our joints have fluid inside that's somewhat similar to oil to keep the bones moving freely. And around the joint, there's a skin layer that keeps the fluid inside the joint. 如果那层皮肤有一个小弱点, it can form a bubble and the normal fluid that's in the joint can enter that bubble. It stretches out that skin lining and then the bubble can get bigger and bigger. And eventually, that bubble can work its way up to be visible beneath the skin. 这就是神经节.
面试官: So it's not just when you see pimple popper videos or whatever online it's oil or it's trapped dermatological fluid. This is something that your joints need to function correctly.
Dr. 罗克韦尔: 是的. It's just normal structures that have moved outside of the joint and usually form under the skin. 但它们仍然附着在关节上.
面试官: 哦,哇. 好吧. And do they only show up on the hands, or can they show up in any joint?
Dr. 罗克韦尔: 他们可以出现在任何地方. 有一些是比较常见的. Palm side of the wrist, the back of the wrist, or the end joint in the finger are common spots. But the back of the knee is another common spot where orthopedists would treat ganglions.
面试官: 现在，有什么特别的原因导致它们? 任何余数, 还是有些人更容易有这些症状, 他们做的一些活动?
Dr. 罗克韦尔: 大部分的关节，大发娱乐不知道. 他们可能, 在某种程度上, 是arthritis-related, but most of the ones in the hand at the wrist don't have a specific arthritic etiology. At the end joint on the finger, there's a definite arthritic etiology. 一般来说，那里有骨刺. The bone spur rubs on that skin inside joint layer and weakens it and allows the bubble to form, 哪个变成了神经节.
面试官: 现在, 有办法吗, 说, identify that it is a kind of ganglion cyst or it's one of these joint fluids, not something else that you should probably not be popping anyway?
Dr. 罗克韦尔: 大多数时候医生都能看出来. 在一般情况下, where a ganglion is there is not something else comparable that would be in the same spot.
For a patient, they may notice that it increases and decreases in size. It is normal joint fluid that's beneath a stretched-out joint lining skin layer. 偶尔, that lining that contains the fluid can weaken and develop a little hole and the fluid may escape from the ganglion, 然后饱腹感就会消失. 液体从皮肤下逸出并被吸收. 没有相关症状.
So if someone notices a mass over the joint that gets bigger and then gets smaller and gets bigger, 这是一个神经节.
面试官: 好吧. So we now know what these things are, where they come from. 现在, I've seen some pretty gnarly videos on the internet. Why or why not should someone pop them or hit them with a book?
Dr. 罗克韦尔: Well, deflating a ganglion in the end is a good treatment. 有一种医学上合适的方法. Popping it at home or hitting it with a book to try to rupture that skin layer may accomplish the same endpoint, but the body won't necessarily see it as a friendly way to treat the ganglion.
So, in the office, rather than popping it, we will put a little needle into it and drain the fluid. 所以在皮肤上放一些利多卡因来麻痹皮肤, 清洁皮肤, 然后把针插进去，把液体吸出来. And about 20% of the time, that will be successful in treating the ganglion.
Eighty percent of the time, unfortunately, the fluid will recur. And then it can be drained again, although most likely if it recurred once, it will recur again. If it recurs once, surgery is the best option to resect the ganglion down to the level of the joint.
面试官: What are some of the potential dangers of, 说, doing it at home by yourself? 这不仅仅是背上的一个大痘痘. 这是连接关节的东西.
Dr. 罗克韦尔: 是的,完全. It's a fluid-filled cavity that has a connection to the joint. So if it's popped at home and an infection develops in the ganglion, the infection has a very short direct route into the joint. And an infected joint would be a horrible outcome from ganglion treatment.
面试官: 天啊. 比如说有人发现自己得了神经节囊肿. 他们现在知道，“嘿，不要在家里治疗.“他们应该去看什么样的医生？? Is this something that you go to a primary care physician, an InstaCare, a dermatologist?
Dr. 罗克韦尔: 如果它在手里, 应该是手外科医生, and hand surgeons are either orthopedic-trained or plastic surgery-trained. If they're in other joints, most likely it would be an orthopedist.
大发娱乐身体的其他大关节, the ganglion would be deeper under the skin or the patient may not actually know there is a ganglion there. But if they have arthritic trouble and are seeing a rheumatologist or an orthopedic surgeon for the arthritis, the doctor would recognize that the ganglion is there and then suggest appropriate treatment.