Styloid stenosis tenosynovitis kuzvimba kunokonzerwa nekurwadziwa nekuzvimba kwe abductor pollicis longus uye extensor pollicis brevis tendons pa dorsal carpal sheath pa radial styloid process. Zviratidzo zvinowedzera kana chigunwe chikawedzera uye calimor deviation. Chirwere ichi chakatanga kutaurwa nachiremba wekuSwitzerland de Quervain muna 1895, saka radial styloid stenosis tenosynovitis inozivikanwawo se de Quervain's disease.
Chirwere ichi chinowanzoonekwa muvanhu vanoita mabasa emaoko nemaoko emuchindwe, uye chinozivikanwawo se "ruoko rwaamai" uye "munwe wemutambo". Nekuvandudzwa kweInternet, huwandu hwevanhu vanobatwa nechirwere ichi huri kuramba huchiwedzera. Saka ungaongorora sei uye urapa sei chirwere ichi? Zvinotevera zvichakupa sumo pfupi kubva pazvinhu zvitatu: chimiro chemuviri, kuongororwa kwekiriniki uye nzira dzekurapa!
I. Maumbirwo emuviri
Maitiro ekugadzira jira remusana ane sulcus yakamanikana, isina kudzika yakafukidzwa ne dorsal carpal ligament inoumba sheath ine fibrous sheath yemapfupa. Abductor pollicis longus tendon uye extensor pollicis brevis tendon dzinopfuura nemusheath iyi dzopetwa nekona uye dzinoguma pasi pefupa rekutanga re metacarpal nepasi pe proximal phalanx yechigunwe, zvichiteerana (Mufananidzo 1). Kana tendon ikatsvedza, pane simba guru rekukweshana, kunyanya kana wrist ulnar deviation kana kufamba kwechigunwe, angle yekupeta ichiwedzera, zvichiwedzera kukweshana pakati pe tendon nemadziro e sheath. Mushure mekukurudzirwa kwenguva refu kwenguva refu, synovium inoratidza shanduko dzekuzvimba dzakadai se edema uye hyperplasia, zvichikonzera kukora, kunamira kana kutetepa kwe tendon nemadziro e sheath, zvichikonzera zviratidzo zve stenosis tenosynovitis.
Mufananidzo 1. Dhayagiramu yemuviri yemaitiro edhiraidhi
II. Kuongororwa kwekiriniki
1. Nhoroondo yezvekurapa inowanzoonekwa muvanhu vane makore epakati nepakati, vanovhiyiwa nemaoko, uye inowanikwawo muvakadzi; Kutanga kunonoka, asi zviratidzo zvinogona kuitika kamwe kamwe.
2. Zviratidzo: kurwadziwa kwenzvimbo iri mukuita kwe styloid ye radius, iyo inogona kupenya kuruoko neruoko, kushaya simba kwechigunwe, kuwedzeredzwa kwechigunwe, kuwedzera kwezviratidzo kana chigunwe chawedzerwa uye kutsauka kwechiuno; Mapundu anonzwika anogona kunzwika pakuita kwe styloid ye radius, akafanana nemapfupa, ane kurwadza kwakanyanya.
3.Kuongororwa kwaFinkelstein (kureva, bvunzo yekutsauka kwechiuno nechiuno) kwakaratidzwa kuti kune positive (sezvinoratidzwa paMufananidzo 2), chigunwe chikuru chinopfumbatidzwa uye chinobatwa muchanza, ruoko rwechiuno rwakatsauka, uye kurwadziwa kwechikamu chepakati pechiuno kunowedzera.
4. Ongororo yekubatsira: Kuongorora X-ray kana ultrasound yemavara kunogona kuitwa kana zvichidikanwa kusimbisa kana paine kusarongeka kwemapfupa kana synovitis. Mitemo yeKurapa Kwemhando Dzakawanda kweStyloid Stenosis Tenosynovitis yeRadius Cherechedza kuti kumwe kuongororwa kwemuviri kunodiwa kuti kuonekwe pakati peosteoarthritis, zvirwere zvebazi repamusoro retsinga yeradial, uye forearm cruciate syndrome panguva yekuongororwa.
III.Kurapa
Kurapa kwekuchengetedza Kurapa kwekudzivirira kufamba kwemunzvimbo: Pakutanga, varwere vanogona kushandisa chibatiso chekunze chekusimbisa kufamba kwemutezo wakabatwa kuderedza mabasa emunzvimbo uye kuderedza kukweshana kwemutezo uri musheath yemutezo kuti vazadzise chinangwa chekurapa. Zvisinei, kudzivirira kufamba kunogona kusaita kuti mutezo wakabatwa uvepo, uye kudzivirira kufamba kwenguva refu kunogona kukonzera kuomarara kwekufamba kwenguva refu. Kunyangwe mamwe marapirwo anobatsirwa nekudzivisa kufamba achishandiswa mukiriniki, kushanda kwekurapa kuchiri kukakavadzana.
Kurapa kweLocal Occlusion: Senzira yekurapa inosarudzwa yekurapa kwekiriniki, kurapwa kweLocal Occlusion kunoreva kubaiwa kwemudumbu panzvimbo yekurwadziwa kuti kubudirire chinangwa cheLocal Anti-Inflammatory Therapy. Kurapa kweOcclusion kunogona kuisa mishonga munzvimbo inorwadza, joint sheath sac, nerve trunk nedzimwe nzvimbo, izvo zvinogona kuderedza kuzvimba nekuderedza marwadzo nekuderedza spasms munguva pfupi, uye kuita basa guru mukurapa maronda eLocal Losses. Kurapa uku kunosanganisira triamcinolone acetonide nelidocaine hydrochloride. Majekiseni eSodium hyaluronate anogonawo kushandiswa. Zvisinei, mahormone anogona kuva nematambudziko akadai sekurwadziwa mushure mekubaiwa jekiseni, ruvara rweganda rweLocal, Local Subcutaneous Tissue Atrophy, Symptomatic Radial Nerve Injury, uye Kuwedzera kweBlood glucose. Zvipingamupinyi zvikuru iHormone Allergy, Varwere vane Pamuviri neVanoyamwisa. Sodium hyaluronate inogona kuva yakachengeteka uye inogona kudzivirira mavanga ekunamatira akakomberedza tendon uye kukurudzira kuporesa kwetendon. Mhedzisiro yekiriniki yeOcclusion therapy iri pachena, asi kune mishumo yekiriniki yeFinger Necrosis inokonzerwa neLocal Jekiseni risingakodzeri (Mufananidzo 3).
Mufananidzo 3 Kuvharika kwechikamu kunotungamira kukufa kwezvigunwe zvemunwe wekunongedza: A. Ganda reruoko rine mavanga, uye B, C. Chikamu chepakati chemunwe wekunongedza chiri kure, uye zvigunwe zvemunwe zvekunongedza zviri necrosis
Nzira dzekudzivirira pakurapa kwe occlusive therapy pakurapa radius styloid stenosis tenosynovitis: 1) Nzvimbo yacho yakarurama, uye sirinji inofanira kubviswa usati wabaya mushonga kuti ive nechokwadi chekuti tsono yejekiseni haipindi mutsinga yeropa; 2) Kudzivirira kwakakodzera nhengo yakakanganiswa kudzivirira kushanda nesimba nguva isati yakwana; 3) Mushure mekubaiwa jekiseni re hormone, kazhinji panowanzova nemarwadzo akasiyana, kuzvimba, uye kunyange kuwedzera kwemarwadzo, kazhinji zvichinyangarika mumazuva 2-3, kana kurwadziwa kweminwe uye kutsvuka kweganda zvikaonekwa, kurapwa kwe antispasmodic uye anticoagulant kunofanira kuitwa nekukurumidza, uye angiography inofanira kuitwa kuti ionekwe zvakajeka kana zvichibvira, uye kuongororwa kwetsinga dzeropa kunofanirwa kuitwa nekukurumidza sezvinobvira kana zvichidikanwa, kuitira kuti kusanonotsa mamiriro acho ezvinhu; 4) Zvinorambidzwa nemahormone zvakaita se BP, chirwere cheshuga, chirwere chemwoyo, nezvimwewo, hazvifanirwe kurapwa ne local occlusion.
Shockwave: mushonga unochengetedza, usingapindi muviri une mukana wekugadzira simba kunze kwemuviri uye kugadzira mhedzisiro munzvimbo dzakanangwa mukati memuviri pasina kukuvadza nyama dzakatenderedza. Une simba rekusimudzira metabolism, kusimbisa kutenderera kweropa ne lymphatic, kuvandudza kudya kwenyama, kubvisa capillaries dzakavharika, uye kusunungura majoini akapfava. Zvisinei, wakatanga kunonoka pakurapa styloid stenosis tenosynovitis ye radius, uye mishumo yekutsvagisa kwayo mishoma, uye zvidzidzo zvakakura zvakarongwa zvichiri kudiwa kuti zvipe humbowo hwakawanda hwekurapa hwakavakirwa pauchapupu kuti husimudzire kushandiswa kwayo mukurapa styloid stenosis tenosynovitis chirwere che radius.
Kurapa neAcupuncture: kurapwa neAcupuncture diki inzira yekusunungura tsinga pakati pekurapwa nekuvhiyiwa, kuburikidza nekubviswa kwezvironda zvemunzvimbo, kunamatira kunoburitswa, uye kubatwa kwetsinga dzeropa kunobviswa zviri nani, uye kutenderera kweropa kwenyama dzakapoteredza kunovandudzwa kuburikidza nekukurudzirwa kweAcupuncture, kuderedza kubuda kwekuzvimba, uye kuzadzisa chinangwa chekurwisa kuzvimba uye marwadzo.
Mishonga yechivanhu yeChinese: Radial styloid stenosis tenosynovitis iri muboka re "paralysis syndrome" mukurapa kwenyika yekwaamai, uye chirwere ichi chakavakirwa pakushomeka uye mwero. Nekuda kwekushanda kwenguva refu kwejoini reruoko, kumanikidzwa kwakanyanya, zvichikonzera kushomeka kweropa neropa munharaunda, izvi zvinonzi kushomeka kwekutanga; Nekuda kwekushomeka kwejini neropa munharaunda, tsandanyama netsinga zvinorasika mukudya uye zvinotsvedza, uye nekuda kwekunzwa mhepo, kutonhora uye hunyoro, izvo zvinowedzera kuvharika kwejini neropa, zvinoonekwa kuti kuzvimba kwenzvimbo nekurwadziwa uye kushanda zvakaganhurirwa, uye kuunganidzwa kwejini neropa kwakanyanya uye spasm yenzvimbo yakakura, saka zvakaonekwa kuti kurwadziwa kwejoini reruoko rinofambiswa uye joini rekutanga remetacarpophalangeal kwakawedzera mukiriniki, inova ndiyo mwero. Zvakaonekwa kuti kurapwa kwemoxibustion, kurapwa kwemasaji, kurapwa kwekunze kwemishonga yechivanhu yeChinese uye kurapwa kweacupuncture kune zvimwe migumisiro yekiriniki.
Kurapa kwekuvhiyiwa: Kuchekwa kwe dorsal carpal ligament ye radius nekubviswa zvishoma ndeimwe yenzira dzekurapa stenosis tenosynovitis mu styloid process ye radius. Yakakodzera varwere vane recurrent tenosynovitis ye radius styloid stenosis, iyo isingashande mushure mekuvharika kwakawanda kwenzvimbo uye mamwe marapirwo anochengetedza, uye zviratidzo zvacho zvakanyanya. Kunyanya kune varwere vane stenotic advanced tenosynovitis, inoderedza marwadzo akaoma uye asingadzoreki.
Kuvhiya zvakananga: Nzira yekuvhiya yakajairika ndeyekucheka zvakananga panzvimbo yakapfava, kuburitsa pachena septum yekutanga yemhasuru yemusana, kucheka sheath yakakora yetendon, uye kusunungura sheath yetendon kuitira kuti tendon ikwanise kutsvedza zvakasununguka mukati me tendon sheath. Kuvhiya zvakananga kunokurumidza kuitika, asi kune njodzi dzakawanda dzekuvhiya dzakadai sehutachiona, uye nekuda kwekubviswa zvakananga kwebhendi rekutsigira dorsal panguva yekuvhiya, kupatsanurwa kwetendon uye kukuvara kwetsinga ye radial netsinga zvinogona kuitika.
Kuvhiya kwekutanga: Nzira iyi yekuvhiya haicheke ganda rakakora retendon, asi inobvisa ganglion cyst inowanikwa mu 1st extensor septum kana kucheka septum iri pakati pe abductor pollicis longus ne extensor pollicis brevis kuti ibudise 1st dorsal extensor septum. Nzira iyi yakafanana nekuvhiya kwakananga, musiyano mukuru uri wekuti mushure mekucheka bhendi rekutsigira extensor, tendon sheath inoburitswa uye tendon sheath inobviswa panzvimbo pekucheka ganda rakakora retendon. Kunyangwe tendon subluxation ingave iripo munzira iyi, inodzivirira 1st dorsal extensor septum uye ine simba renguva refu rekusimbisa tendon pane kubviswa zvakananga kwetendon sheath. Dambudziko renzira iyi rinonyanya kukonzerwa nekuti ganda rakakora retendon haribviswi, uye ganda rakakora retendon rinogona kunge richiri kuzvimba, kuzvimba, uye kukweshana netendon kuchaita kuti chirwere chidzoke zvakare.
Kuwedzerwa kwetsinga dzemusana dzinoita searthroscopic osteofibrous: kurapwa kwe arthroscopic kune zvakanakira zvekukuvara kushoma, kutenderera kwenguva pfupi kwekurapwa, kuchengetedzeka kwakanyanya, matambudziko mashoma uye kupora nekukurumidza, uye mukana mukuru ndewekuti bhandi rekutsigira re extensor harina kuchekwa, uye hapazovi nekubviswa kwetsinga. Zvisinei, kuchine gakava, uye vamwe vadzidzi vanotenda kuti kuvhiyiwa kwe arthroscopic kunodhura uye kunotora nguva, uye zvakanakira zvako kupfuura kuvhiyiwa kwakananga hakuonekwe zvakakwana. Saka, kurapwa kwe arthroscopic kazhinji hakusarudzwi nevazhinji vanachiremba nevarwere.
Nguva yekutumira: Gumiguru-29-2024
