I-Styloid stenosis tenosynovitis kukuvuvukala kwe-aseptic okubangelwa yintlungu kunye nokudumba kwe-abductor pollicis longus kunye ne-extensor pollicis brevis tendons kwi-dorsal carpal sheath kwinkqubo ye-radial styloid. Iimpawu ziba mandundu ngokwandiswa kobhontsi kunye nokuphambuka kweCalimor. Esi sifo saxelwa okokuqala ngugqirha wotyando waseSwitzerland u-Quervain ngo-1895, ngoko ke i-radial styloid stenosis tenosynovitis yaziwa ngokuba sisifo sika-Quervain.
Esi sifo sixhaphake kakhulu kubantu abenza imisebenzi rhoqo yesandla kunye nesandla somnwe, kwaye saziwa ngokuba “yisandla sikamama” kunye “nomnwe womdlalo”. Ngophuhliso lwe-Intanethi, inani labantu abachatshazelwa sesi sifo liyanda kwaye lincinci. Ngoko indlela yokuxilonga kunye nokunyanga esi sifo? Oku kulandelayo kuya kukunika isingeniso esifutshane kwiinkalo ezintathu: isakhiwo se-anatomical, ukuxilongwa kwekliniki kunye neendlela zonyango!
I.Anatomy
Inkqubo ye-styloid yeradiyasi ine-sulcus emxinwa, engekho nzulu egqunywe yi-dorsal carpal ligament eyenza i-sheath fibrous of bony. I-abductor pollicis longus tendon kunye ne-extensor pollicis brevis tendon idlula kule sheath kwaye isonge nge-angle kwaye iphele kwisiseko sethambo lokuqala le-metacarpal kunye nesiseko se-phalanx ejikelezayo yesithupha, ngokulandelanayo (Umfanekiso 1). Xa i-tendon isilayidi, kukho amandla amakhulu okuxubana, ngakumbi xa ukuphambuka kwe-ulnar yesandla okanye ukunyakaza kwesithupha, i-angle ye-fold fold iyanda, inyusa i-friction phakathi kwe-tendon kunye nodonga lwe-sheath. Emva kokuvuselela okungapheliyo kwexesha elide, i-synovium ibonisa utshintsho oluvuthayo olufana ne-edema kunye ne-hyperplasia, ebangela ukuqina, ukunamathela okanye ukucutha kwe-tendon kunye nodonga lwe-sheath, okubangelwa ukubonakaliswa kwekliniki ye-stenosis tenosynovitis.
Umzobo we-1 umzobo we-anatomical wenkqubo ye-styloid ye-radius
II.Ukuxilongwa kwezonyango
I-1.Imbali yonyango ixhaphake kakhulu kwi-middle-aged operators, kwaye ixhaphake kubasetyhini; Ukuqala kucotha, kodwa iimpawu zingenzeka ngesiquphe.
I-2.Izibonakaliso: iintlungu zengingqi kwinkqubo ye-styloid ye-radius, enokuthi ikhuphe kwisandla kunye ne-forearm, ubuthathaka besithupha, ulwandiso oluncinci lwesithupha, ukunyanzeliswa kweempawu xa ukwandiswa kwesithupha kunye nokuphambuka kwe-ulnar yesandla; Amaqhuqhuva abambekayo asenokuvakala kwinkqubo yesitayile seradiyasi, afane nokuphakama kwethambo, ngokuthamba okuphawulweyo.
3.Uvavanyo lukaFinkelstein (oko kukuthi, uvavanyo lwe-fist ulnar deviation test) lulungile (njengoko kuboniswe kuMfanekiso 2), isithupha siguquguquka kwaye sibanjwe entendeni, i-wrist ye-ulnar iyaphambuka, kwaye intlungu kwi-radius styloid process iyancipha.
4.Uviwo oluncedisayo: Uviwo lwe-X-ray okanye umbala we-ultrasound lunokwenziwa ukuba kuyimfuneko ukuqinisekisa ukuba kukho ukungaqhelekanga kwamathambo okanye i-synovitis. Izikhokelo ze-Multidisciplinary Treatment of Styloid Stenosis Tenosynovitis of the Radius Qaphela ukuba ezinye iimviwo zomzimba ziyafuneka ukuze zihlukanise phakathi kwe-osteoarthritis, ukuphazamiseka kwesebe elingaphezulu le-nerve ye-radial, kunye ne-forearm cruciate syndrome ngexesha lokuxilongwa.
III.Unyango
I-Conservative therapyUnyango lwe-immobilization yengingqi: Kwinqanaba lokuqala, izigulane zingasebenzisa i-brace yokulungiswa kwangaphandle ukuze kungabikho umlenze ochaphazelekayo ukunciphisa imisebenzi yendawo kunye nokunciphisa ukungqubuzana kwe-tendon kwi-tendon sheath ukufezekisa injongo yonyango. Nangona kunjalo, ukunyanzeliswa akunakuqinisekisa ukuba ilungu elichaphazelekayo likhona, kwaye ukukhutshwa kwexesha elide kunokubangela ukuqina kwexesha elide. Nangona i-immobilization-incediswa kwezinye iindlela zonyango zisetyenziswa ngamandla kwiklinikhi, ukusebenza konyango kuhlala kuyimpikiswano.
Unyango lwe-occlusion lwengingqi: Njengonyango olukhethiweyo olukhethiweyo lonyango lweklinikhi, unyango lwe-occlusion lwendawo lubhekiselele kwi-injection ye-intrathecal kwindawo yentlungu yendawo ukufezekisa injongo ye-anti-inflammatory yendawo. Unyango lwe-Occlusive lunokuthi lufake iziyobisi kwindawo ebuhlungu, i-joint sheath sac, i-trunk ye-nerve kunye nezinye iindawo, ezinokunciphisa ukudumba kunye nokunciphisa intlungu kunye nokukhulula i-spasms ngexesha elifutshane, kwaye idlale indima enkulu kunyango lwezilonda zendawo. Unyango lubandakanya ikakhulu i-triamcinolone acetonide kunye ne-lidocaine hydrochloride. Iinaliti zesodium hyaluronate nazo zingasetyenziswa. Nangona kunjalo, iihomoni zinokuba neengxaki ezinje ngeentlungu zangemva kokutofa, ibala lesikhumba lendawo, i-atrophy ye-subcutaneous tissue atrophy, i-symptomatic radial nerve injury, kunye ne-glucose ephezulu yegazi. Eyona nto ichaseneyo yi-hormone allergy, izigulane ezikhulelweyo kunye nabancancisayo. I-Sodium hyaluronate inokuthi ikhuseleke kwaye inokuthintela ukukrala kokunamathela kwi-tendon kunye nokukhuthaza ukuphulukiswa kwe-tendon. Impembelelo yeklinikhi yonyango lwe-occlusive ibonakala, kodwa kukho iingxelo zeklinikhi ze-necrosis yomnwe obangelwa yi-injection engafanelekanga yendawo (Umfanekiso 3).
Umzobo.3 Ukuvalelwa okuyingxenye kukhokelela kwi-necrosis yeminwe yeminwe yesalathisi: A. Isikhumba sesandla sinamabala, kunye ne-B, C. Icandelo eliphakathi kwesalathisi likude, kwaye iminwe i-necrosis.
Izilumkiso zonyango lwe-occlusive kunyango lwe-radius styloid stenosis tenosynovitis: 1) Isikhundla sichanekile, kwaye i-syringe kufuneka ihoxiswe ngaphambi kokutofa iyeza ukuze kuqinisekiswe ukuba inaliti yokutofa ayingeni kwisitya segazi; I-2) Ukunyanzeliswa okufanelekileyo kwelungu elichaphazelekayo ukuphepha ukuxhatshazwa kwangaphambili; 3) Emva kwenaliti ye-hormone occlusion, kukho amanqanaba ahlukeneyo entlungu, ukudumba, kunye nokunyuka kweentlungu, ezihlala ziphela kwiintsuku ze-2 ~ 3, ukuba iintlungu zeminwe kunye ne-pallor ibonakala, unyango lwe-antispasmodic kunye ne-anticoagulant kufuneka lunikwe ngokukhawuleza, kwaye i-angiography kufuneka yenziwe ukwenza ukuxilongwa okucacileyo ukuba kunokwenzeka, kunye nokuhlolwa kwemithambo yegazi kufuneka kuqhutywe, ngoko nangoko ukuba kuyimfuneko ukulibazisa. 4) Ukuchasana kweHormonal ezifana noxinzelelo lwegazi, isifo sikashukela, isifo senhliziyo, njl., Akufanele kuphathwe ngokuvalelwa kwendawo.
I-Shockwave: lunyango olulondolozayo, olungenalo ukuphazamisa olunenzuzo yokuvelisa amandla ngaphandle komzimba kunye nokuvelisa iziphumo kwiindawo ezijoliswe kuzo ngaphakathi emzimbeni ngaphandle kokonakalisa izicubu ezijikelezileyo. Inefuthe lokukhuthaza imetabolism, ukomeleza igazi kunye nokujikeleza kwe-lymphatic, ukuphucula isondlo kwizicubu, ukukhupha ii-capillaries ezivaliweyo, kunye nokukhulula ukunamathela kwezicubu ezithambileyo. Nangona kunjalo, yaqala emva kwexesha kunyango lwe-styloid stenosis tenosynovitis yeradius, kwaye iingxelo zayo zophando zimbalwa, kwaye izifundo ezinkulu ezilawulwa ngokungenamkhethe zisafuneka ukunika ubungqina obungakumbi obusekelwe kubungqina bezonyango ukukhuthaza ukusetyenziswa kwayo kunyango lwe-styloid stenosis tenosynovitis isifo seradius.
Unyango lwe-acupuncture: Unyango oluncinci lwe-acupuncture yindlela yokukhululwa evaliweyo phakathi konyango lotyando kunye nonyango olungasebenzisi utyando, ngokucofa kunye nokuxobula izilonda zasekhaya, ukuncamathela kukhululwe, kwaye ukubanjwa kwe-vascular nerve bundle kukhululwa ngempumelelo, kwaye ukujikeleza kwegazi kwizicubu ezijikelezileyo kuphuculwe ngokuvuselela i-benign, ukuvuvukala kunye nokuvuvukala. injongo ye-anti-inflammatory kunye ne-analgesic.
Iyeza lesiNtu lesiShayina: I-Radial styloid stenosis tenosynovitis yeyodidi lwe "paralysis syndrome" kwiyeza lelizwe lomama, kwaye isifo sisekelwe kwintsilelo kunye nomgangatho. Ngenxa yomsebenzi wexesha elide we-wrist joint, ubunzima obugqithiseleyo, okubangelwa i-qi yendawo kunye nokusilela kwegazi, oku kubizwa ngokuba yintsilelo yokuqala; Ngenxa ye-qi yendawo kunye nokunqongophala kwegazi, izihlunu kunye nemithambo zilahlekile kwisondlo kunye nokutyibilika, kwaye ngenxa yemvakalelo yomoya, ukubanda kunye nokumanzi, okwenza kube nzima ukuvaleka kwe-qi kunye nokusebenza kwegazi, kubonakala ukuba ukudumba kwendawo kunye neentlungu kunye nomsebenzi zithintelwe, kwaye ukuqokelelwa kwe-qi kunye negazi kubaluleke kakhulu ukuba i-mova ibonakale ibuhlungu kakhulu kwaye ibuhlungu kakhulu. isihlahla esihlangeneyo kunye nejoyinti yokuqala ye-metacarpophalangeal iyancipha kwikliniki, esemgangathweni. Kwafunyaniswa ngokweklinikhi ukuba unyango lwe-moxibustion, unyango lwe-massage, unyango lwangaphandle lwamayeza emveli aseTshayina kunye nonyango lwe-acupuncture luneziphumo ezithile zeklinikhi.
Unyango lotyando: Ukusikwa kotyando lwe-dorsal carpal ligament ye-radius kunye nokukhutshwa okulinganiselweyo yenye yonyango lwe-stenosis tenosynovitis kwinkqubo ye-styloid ye-radius. Ifanelekile kwizigulane ezine-tenosynovitis ephindaphindiweyo ye-radius styloid stenosis, engazange isebenze emva kokuvalelwa kweengingqi ezininzi kunye nolunye unyango olulondolozayo, kwaye iimpawu zinzima. Ngokukodwa kwizigulane ezine-stenotic advanced tenosynovitis, ikhulula intlungu enzima kunye ne-refractory.
Utyando oluvulekileyo ngokuthe ngqo: Indlela yotyando oluqhelekileyo kukwenza i-incision ngokuthe ngqo kwindawo yethenda, ukuveza i-septum yokuqala ye-dorsal muscle, ukusika i-tendon sheath, kwaye ukhulule i-tendon sheath ukuze i-tendon ikwazi ukuslayida ngokukhululekile ngaphakathi kwe-tendon sheath. Utyando oluvulekileyo oluthe ngqo lukhawuleza ukufezekiswa, kodwa luthwala uluhlu lweengozi zotyando ezifana nokusuleleka, kwaye ngenxa yokususwa ngokuthe ngqo kwebhendi yokuxhasa i-dorsal ngexesha lotyando, ukuchithwa kwe-tendon kunye nomonakalo kwi-nerve ye-radial kunye ne-vein ingenzeka.
I-1st septolysis: Le ndlela yokuhlinzwa ayinqumli i-tendon sheath, kodwa isusa i-cyst ye-ganglion efunyenwe kwi-1st extensor septum okanye inqumle i-septum phakathi kwe-abductor pollicis longus kunye ne-extensor pollicis brevis ukukhulula i-1st dorsal extensor septum. Le ndlela ifana notyando oluvulekileyo oluthe ngqo, umahluko omkhulu kukuba emva kokusika ibhendi yokuxhasa i-extensor, i-tendon sheath ikhululiwe kwaye i-tendon sheath isuswe endaweni yokusikwa kwe-tendon sheath. Nangona i-tendon subluxation ingaba khona kule ndlela, ikhusela i-1st dorsal extensor septum kwaye inokusebenza okuphezulu kwexesha elide lokuzinza kwe-tendon kunokutshatyalaliswa ngokuthe ngqo kwe-tendon sheath. Ukungalungi kwale ndlela kubangelwa ikakhulu kukuba i-tendon sheath ejiyileyo ayisuswanga, kwaye i-tendon sheath ejiyileyo isenokuthi ibe nokudumba, i-edema, kunye nokungqubana ne-tendon kuya kukhokelela ekuphindeni kwesi sifo.
I-Arthroscopic osteofibrous duct augmentation: unyango lwe-arthroscopic lunenzuzo yokulimala okuncinci, umjikelezo wonyango olufutshane, ukhuseleko oluphezulu, iingxaki ezimbalwa kunye nokubuyisela ngokukhawuleza, kwaye inzuzo enkulu kukuba ibhanti yokuxhasa i-extensor ayifakwanga, kwaye ayiyi kuba ne-tendon dislocation. Nangona kunjalo, kusekho ukuphikisana, kwaye abanye abaphengululi bakholelwa ukuba utyando lwe-arthroscopic lubiza kwaye ludla ixesha, kwaye inzuzo yalo phezu kotyando oluvulekileyo alubonakali ngokwaneleyo. Ngoko ke, unyango lwe-arthroscopic ngokuqhelekileyo alukhethwa luninzi lwamagqirha kunye nezigulane.
Ixesha lokuposa: Oct-29-2024
