Acupotomology originated from traditional Chinese medicine, and gradually absorb modern anatomical theories. It is easily accepted by the patients because it has the advantages of simple operation, no condition limitation, minimal invasive, small damage to the body tissue, rare in inducing infection, low adverse reaction and quick recovery. In clinical practice, acupotomology is usually used for the treatment of chronic soft tissue injury and also suitable for traumatic bursitis, tenosynovitis, and muscle fasciitis. In our hospital, we have cured ganglion cysts with the acupotomy therapy. Our study demonstrates that patients who received the new combined treatment of acupotomy and crisscross thread had pain level similar to the patients who received treatment of aspiration followed by steroid injection, and had less pain than the people who experienced open excision.
There are various treatments being tried out for permanent cure of ganglion cysts, and all these treatments have different recurrence rates. The recurrence rate of blunt force is 44.7%, while aspiration 15%-69%. Moreover, a number of techniques have been developed to close the potential space of the empty cysts and to prevent recurrence, including aspiration with multiple punctures of the wall and aspiration with injection of steroid or hyaluronidase. However, the recurrent rate of aspiration with steroid is 14%-83%, aspiration with multiple puncture 49%-78%, aspiration with sclerotherapy varying between 10%-35%. The recurrence rate is 36.7% in our research of aspiration with steroid group, it is similar to previous reports. Surgical excision remains the golden standard for treatment of ganglion cysts and it is the choice when conservative treatment fails. In most previous studies, the recurrence rate of surgical excision varies from 3.8–42%[2, 10]. One meta-analysisfound that open excision had a mean recurrence of 21%, reduced by 76% in recurrence compared with aspiration. The above meta-analysis reported the recurrence of arthroscopic excision was 6% across all studies. Chung found their recurrence of arthroscopic excision was 10%. In our study, the recurrent rate of the open excision was 10.71%, which was consistent with previous studies. But surgical excision is usually accompanied by many complications, including unsightly scar, infection, keloid, radial artery injury and neurapraxia, decreased range of motion, postoperative stiffness, grip weakness. One meta-analysis reported the complication incidence of open excision was 14%, while arthroscopic excision was 4%. In our view, some complications could be avoided by the combined treatment. As a kind of closed lysis between surgery and non-surgery, the acupotomy therapy is a minimally invasive method. It has no incision and its surgical trauma is minor. In our hospital, there was no patient had infection or other complications in any group.
Several other thread techniques was also reported. Rathod introduced the transfixation technique, by which two sterile silk sutures were passed through the cyst at right angles to each other, the content of the cyst were aspirated using a syringe needle, and the threads was tied over the cyst over a sterile gauze firmly. They reported the failure rate was 5%. Mohandescribed the same thread technique without aspiration of the cyst content, their recurrent rate was 5.56%. Zanganareported another thread technique–when the ganglion content was aspirated, one silk thread was passed through the ganglion horizontally and tied to a silk ring, and the patients were advised to rotate the silk ring and apply gentle digital pressure on the ganglion interval every day. They found the recurrence rate was 4% finally. Compared with previously reported thread techniques, the novel feature of our technique was coalesced with acupotomy, which originated from traditional Chinese medicine. In our study, the recurrent rate of the new combined treatment was 3.7%, which was a little lower than other thread technique. This may be because the lining of the cysts wall was damaged by the multiple punctures of the acupotomy, and a low grade chronic inflammation was caused by the silk thread between cysts walls. What’s more, adequate pressure produced by the cotton ball was conducive to closing the potential space of the empty cyst.
There is few report about the cost of the ganglion cysts treatment. One rearchfrom Stanford University of America showed that the average total cost of an open excision was $1,821± $1,127 ,while an arthroscopic excision was $3,668 ± $872, Surgical costs from arthroscopic ganglion excision are significantly higher than open excision. In our hospital, open excision cost was only ¥3061.11 ± 474.72, which was much less than that in America. The new combined treatment cost about ¥ 476.89 ± 40.43, and aspiration with steroid group was ¥ 322.39 ± 60.90. Groups A and B spent much less than Group C so that the financial burden of patients was reduced greatly.