I-Styloid stenosis tenosynovitis kukudumba okungenabungozi okubangelwa yintlungu kunye nokudumba kwe-abductor pollicis longus kunye ne-extensor pollicis brevis tendons kwi-dorsal carpal sheath kwinkqubo ye-radial styloid. Iimpawu ziya zisiba mandundu xa uthupha lunwetshwa kwaye i-calimor deviation iguquka. Esi sifo saxelwa okokuqala ngugqirha waseSwitzerland u-de Quervain ngo-1895, ngoko ke i-radial styloid stenosis tenosynovitis ikwaziwa ngokuba sisifo sika-de Quervain.
Esi sifo sixhaphake kakhulu kubantu abenza imisebenzi yesandla neminwe yesundu rhoqo, kwaye saziwa ngokuba “yisandla sikamama” kunye “nomnwe womdlalo”. Ngophuhliso lwe-Intanethi, inani labantu abachaphazeleka sesi sifo liya likhula kwaye liba ncinci. Ngoko ke ungasixilonga njani kwaye usinyange esi sifo? Oku kulandelayo kuza kukunika intshayelelo emfutshane kwiinkalo ezintathu: isakhiwo somzimba, ukuxilongwa kweklinikhi kunye neendlela zonyango!
I. I-Anatomy
Inkqubo yesitayile yeradius ine-sulcus encinci, enganzulu egqunywe yi-dorsal carpal ligament eyenza i-fibrous sheath yethambo. I-abductor pollicis longus tendon kunye ne-extensor pollicis brevis tendon zidlula kule sheath kwaye zigobe nge-engile kwaye ziphele kwisiseko sethambo lokuqala le-metacarpal kunye nesiseko se-proximal phalanx yesithupha, ngokulandelanayo (Umfanekiso 1). Xa i-tendon ityibilika, kukho amandla amakhulu okungqubana, ngakumbi xa ukuphambuka kwe-ulnar yesandla okanye intshukumo yesithupha, i-engile yokugoba iyanda, okwandisa ukungqubana phakathi kwe-tendon kunye nodonga lwe-sheath. Emva kokuvuselelwa okungapheliyo okuphindaphindwayo ixesha elide, i-synovium ibonisa utshintsho oluvuthayo olufana ne-edema kunye ne-hyperplasia, okubangela ukutyeba, ukunamathela okanye ukuncitshiswa kwe-tendon kunye nodonga lwe-sheath, okubangela iimpawu zeklinikhi ze-stenosis tenosynovitis.
Umzobo 1 Umzobo wokwakheka kwenkqubo yesitayile seradiyumu
II. Ukuxilongwa kwezonyango
1. Imbali yezonyango ixhaphake kakhulu kubantu abaneminyaka ephakathi, abenza utyando ngesandla, kwaye ixhaphake kakhulu kwabasetyhini; Ukuqala kwayo kuhamba kancinci, kodwa iimpawu zinokuvela ngequbuliso.
2.Iimpawu: iintlungu ezikwindawo ethile kwinkqubo yesitayile seradius, enokuphuma iye esandleni nakwingalo, ubuthathaka besithupha, ukwandiswa okuncinci kwesithupha, ukwanda kweempawu xa kwandiswa ubhontsi kunye nokuphambuka kwesandla esinqeni; Amaqhuqhuva avakalayo anokuvakala kwinkqubo yesitayile seradius, efana nobukhulu bethambo, kunye nokuthamba okuphawulekayo.
3.Uvavanyo lukaFinkelstein (oko kukuthi, uvavanyo lokuphambuka kwe-ulnar fist) lulungile (njengoko kubonisiwe kuMfanekiso 2), ubhontsi uyagoba kwaye ubanjwe entendeni yesandla, isihlakala se-ulnar siyajika, kwaye intlungu kwinkqubo ye-radius styloid iba mandundu.
4. Uvavanyo oluncedisayo: Uvavanyo lwe-X-ray okanye i-ultrasound yombala lunokwenziwa ukuba kuyimfuneko ukuqinisekisa ukuba kukho ukungaqheleki kwamathambo okanye i-synovitis. Izikhokelo zoNyango lweeNgcali ezininzi zeStyloid Stenosis I-Tenosynovitis yeRadius Qaphela ukuba kufuneka olunye uvavanyo lomzimba ukuze kwahlulwe phakathi kwe-osteoarthritis, ukuphazamiseka kwesebe elingaphezulu le-radial nerve, kunye ne-forearm cruciate syndrome ngexesha lokuxilongwa.
III. Unyango
Unyango oluzinzileyoUnyango lwendawo oluthintela ukunyakaza: Kwinqanaba lokuqala, izigulana zingasebenzisa i-external fixation brace ukuthintela ilungu elichaphazelekayo ukunciphisa imisebenzi yasekuhlaleni kunye nokunciphisa ukungqubana kwe-tendon kwi-tendon sheath ukufezekisa injongo yonyango. Nangona kunjalo, ukungasebenzi kusenokungaqinisekisi ukuba ilungu elichaphazelekayo likhona, kwaye ukungasebenzi ixesha elide kunokubangela ukuqina kokunyakaza ixesha elide. Nangona ezinye iindlela zonyango ezincediswa kukungasebenzi zisetyenziswa ngokweengcali zonyango, ukusebenza kakuhle konyango kusaphikisana.
Unyango lokuvaleka kwesikhumba: Njengonyango oluthandwayo lonyango lweklinikhi, unyango lokuvaleka kwesikhumba lubhekisa ekufakweni kwamayeza ngaphakathi kwesikhumba kwindawo yentlungu ukuze kufezekiswe injongo yokulwa nokuvuvukala kwesikhumba. Unyango oluvalekayo lunokufaka amayeza kwindawo ebuhlungu, kwingxowa yesheath yamalungu, kwisiqu semithambo-luvo nakwezinye iindawo, anokunciphisa ukudumba nokunciphisa iintlungu nokunciphisa ukuqaqamba ngexesha elifutshane, kwaye adlale indima enkulu kunyango lwezilonda zasekuhlaleni. Unyango luquka ikakhulu i-triamcinolone acetonide kunye ne-lidocaine hydrochloride. Iinaliti ze-sodium hyaluronate nazo zingasetyenziswa. Nangona kunjalo, iihormone zinokuba neengxaki ezifana nentlungu emva kokufakwa kwenaliti, umbala wesikhumba wasekuhlaleni, ukuwohloka kwezicubu ezingaphantsi komhlaba, ukwenzakala kwemithambo-luvo ye-radial, kunye ne-glucose ephezulu yegazi. Izinto eziphambili ezichaseneyo yi-allergy ye-hormone, izigulane ezikhulelweyo nezincancisayo. I-sodium hyaluronate inokuba ikhuselekile kwaye inokuthintela ukuvaleka kokunamathela okujikeleze i-tendon kwaye ikhuthaze ukuphiliswa kwe-tendon. Isiphumo seklinikhi sonyango oluvalekayo sicacile, kodwa kukho iingxelo zeklinikhi ze-necrosis yeminwe ebangelwa kukufakwa kwenaliti okungafanelekanga kwamalungu (Umfanekiso 3).
Umzobo 3 Ukuvaleka okuncinci kukhokelela kwi-necrosis yeminwe yeminwe yesandla: A. Ulusu lwesandla lunamabala, kwaye u-B, u-C. Inxalenye ephakathi yomnwe wesandla ikude kakhulu, kwaye iminwe yesandla yi-necrosis
Amanyathelo okuthintela unyango lwe-occlusive kunyango lwe-radius styloid stenosis tenosynovitis: 1) Indawo eme kuyo ichanekile, kwaye i-syringe kufuneka irhoxiswe ngaphambi kokufaka iyeza ukuqinisekisa ukuba inaliti yenaliti ayingeni emthanjeni wegazi; 2) Ukuthintela ngokufanelekileyo ilungu elichaphazelekayo ukuze kuthintelwe ukuqina kwangethuba; 3) Emva kokufakwa kwe-hormone occlusion, kuhlala kukho amanqanaba ahlukeneyo entlungu, ukudumba, kunye nokwanda kwentlungu, okuhlala kunyamalala kwiintsuku ezi-2 ~ 3, ukuba iintlungu zeminwe kunye ne-pallor ziyavela, unyango lwe-antispasmodic kunye ne-anticoagulant kufuneka lunikwe ngokukhawuleza, kwaye kufuneka kwenziwe i-angiography ukuze kwenziwe uxilongo olucacileyo ukuba kunokwenzeka, kwaye kufuneka kuhlolwe imithambo yegazi ngokukhawuleza ukuba kuyimfuneko, ukuze kungalibazisi imeko; 4) Izithintelo ze-hormone ezifana noxinzelelo lwegazi, isifo seswekile, isifo sentliziyo, njl.njl., akufuneki ziphathwe nge-local occlusion.
I-Shockwave: lunyango olugcinayo, olungangenisi ntsholongwane olunengenelo yokuvelisa amandla ngaphandle komzimba kwaye luvelise iziphumo kwiindawo ezijoliswe kuzo nzulu emzimbeni ngaphandle kokonakalisa izicubu ezijikelezileyo. Inefuthe lokukhuthaza imetabolism, ukuqinisa ukujikeleza kwegazi kunye ne-lymphatic, ukuphucula isondlo sezicubu, ukukrazula ii-capillaries ezivaliweyo, kunye nokukhulula ukunamathelana kwezicubu ezithambileyo. Nangona kunjalo, yaqala emva kwexesha kunyango lwe-styloid stenosis tenosynovitis yeradius, kwaye iingxelo zayo zophando zimbalwa kakhulu, kwaye izifundo ezinkulu ezilawulwa ngokungacwangciswanga zisafuneka ukubonelela ngobungqina obuninzi bezonyango obusekelwe kubungqina ukukhuthaza ukusetyenziswa kwayo kunyango lwe-styloid stenosis tenosynovitis isifo seradius.
Unyango lwe-acupuncture: unyango lwe-acupuncture encinci yindlela yokukhulula evaliweyo phakathi konyango lotyando kunye nonyango olungelulo utyando, ngokukrazula nokuxobuka kwezilonda zasekuhlaleni, ukunamathela kuyakhululwa, kwaye ukuvaleka kwe-vascular nerve bundle kuyakhululeka ngakumbi, kwaye ukujikeleza kwegazi kwezicubu ezijikelezileyo kuphuculwe ngokuvuselela okungenabungozi kwe-acupuncture, ukunciphisa ukukhupha ukuvuvukala, kunye nokufezekisa injongo yokulwa nokuvuvukala kunye ne-analgesic.
Amayeza esintu aseTshayina: I-Radial styloid stenosis tenosynovitis ikwicandelo le-"paralysis syndrome" kumayeza elizwe, kwaye esi sifo sisekelwe kukungabikho kunye nomgangatho. Ngenxa yomsebenzi wexesha elide welungu lesandla, uxinzelelo olugqithisileyo, okubangela i-qi yendawo kunye nokungabikho kwegazi, oku kubizwa ngokuba kukungabikho kokuqala; Ngenxa ye-qi yendawo kunye nokungabikho kwegazi, izihlunu kunye nemithambo ziyalahleka ekutyeni nasekutyibilikeni, kwaye ngenxa yokuziva komoya, ukubanda kunye nokufuma, okwandisa ukuvaleka kwe-qi kunye nokusebenza kwegazi, kubonakala ukuba ukudumba kwendawo kunye nentlungu kunye nomsebenzi kuyathintelwa, kwaye ukuqokelelwa kwe-qi kunye negazi kukhulu kwaye ukuxinana kwendawo kukhulu, ngoko ke kufunyaniswe ukuba intlungu yelungu lesandla elishukumayo kunye nelungu lokuqala le-metacarpophalangeal iyakhula ekliniki, okuqhelekileyo. Kwafunyaniswa ngokwezonyango ukuba unyango lwe-moxibustion, unyango lwe-massage, unyango lwangaphandle lwamayeza esintu aseTshayina kunye nonyango lwe-acupuncture luneziphumo ezithile zonyango.
Unyango lotyando: Ukusika ngotyando kwe-dorsal carpal ligament yeradius kunye nokususwa okulinganiselweyo yenye yeendlela zonyango lwe-stenosis tenosynovitis kwinkqubo ye-styloid yeradius. Ifanelekile kwizigulana ezine-tenosynovitis ephindaphindayo ye-radius styloid stenosis, engasebenzi kakuhle emva kokuvaleka okuninzi kwendawo kunye nolunye unyango olugcina imithambo, kwaye iimpawu zinzima. Ingakumbi kwizigulana ezine-stenotic advanced tenosynovitis, ithomalalisa iintlungu ezinzima nezinganyangekiyo.
Utyando oluvulekileyo ngokuthe ngqo: Indlela eqhelekileyo yotyando kukwenza utyando oluvulekileyo ngokuthe ngqo kwindawo ethambileyo, ukuveza i-septum yokuqala yemisipha yangasemva, ukusika i-tendon sheath etyebileyo, kunye nokukhulula i-tendon sheath ukuze i-tendon ikwazi ukutyibilika ngokukhululekileyo ngaphakathi kwe-tendon sheath. Utyando oluvulekileyo ngokuthe ngqo lukhawuleza lufezekiswe, kodwa luthwala uthotho lweengozi zotyando ezifana nosulelo, kwaye ngenxa yokususwa ngokuthe ngqo kwe-dorsal support band ngexesha lotyando, ukusasazeka kwe-tendon kunye nomonakalo kwi-radial nerve kunye ne-vein kunokwenzeka.
I-septolysis yokuqala: Le ndlela yotyando ayinqumli i-tendon sheath etyebileyo, kodwa isusa i-ganglion cyst efumaneka kwi-1st extensor septum okanye inqumle i-septum ephakathi kwe-abductor pollicis longus kunye ne-extensor pollicis brevis ukuze kukhutshwe i-1st dorsal extensor septum. Le ndlela ifana notyando oluvulekileyo ngqo, umahluko ophambili kukuba emva kokusika i-extensor support band, i-tendon sheath iyakhululwa kwaye i-tendon sheath isuswa endaweni yokusikwa kwe-tendon sheath etyebileyo. Nangona i-tendon subluxation inokubakho kule ndlela, ikhusela i-1st dorsal extensor septum kwaye isebenza kakuhle ixesha elide ukuzinza kwe-tendon kunokusikwa ngokuthe ngqo kwe-tendon sheath. Ukungalungi kwale ndlela ikakhulu kungenxa yokuba i-tendon sheath etyebileyo ayisuswanga, kwaye i-tendon sheath etyebileyo isenokuba nokuvuvukala, ukudumba, kunye nokungqubana ne-tendon kuya kukhokelela ekubuyeni kwesi sifo.
Ukwandiswa kwe-arthroscopic osteofibrous duct: unyango lwe-arthroscopic luneengenelo zokungabi nazintlungu zingako, umjikelo omfutshane wonyango, ukhuseleko oluphezulu, iingxaki ezimbalwa kunye nokuchacha ngokukhawuleza, kwaye inzuzo enkulu kukuba ibhanti yokuxhasa i-extensor ayinqunyulwanga, kwaye akuyi kubakho kukhubeka kwemisipha. Nangona kunjalo, kusekho impikiswano, kwaye abanye abaphengululi bakholelwa ukuba utyando lwe-arthroscopic lubiza kakhulu kwaye luthatha ixesha, kwaye iingenelo zalo ngaphezu kotyando oluvulekileyo ngqo azibonakali ngokwaneleyo. Ke ngoko, unyango lwe-arthroscopic ngokubanzi alukhethwa ngoogqirha abaninzi kunye nezigulane.
Ixesha leposi: Okthobha-29-2024
