Styloid stenosis tenosynovitis kuzvimba kweaseptic kunokonzerwa nekurwadziwa uye kuzvimba kweabductor pollicis longus uye extensor pollicis brevis tendons padorsal carpal sheath paradial styloid process. Zviratidzo zvinowedzera kuipa nekuwedzerwa kwechigunwe uye kutsauka kwechimiro. Chirwere ichi chakatanga kutaurwa nachiremba wekuSwitzerland de Quervain muna 1895, saka radial styloid stenosis tenosynovitis inozivikanwawo sechirwere cheQuervain.
Chirwere ichi chinowanzoitika muvanhu vanogaroita mabasa emaoko neminwe, uye inozivikanwawo se "ruoko rwaamai" uye "chigunwe chemutambo". Nekuvandudzwa kweInternet, nhamba yevanhu vanobatwa nechirwere ichi iri kuwedzera uye vaduku. Saka sei kuongorora uye kubata chirwere ichi? Izvi zvinotevera zvinokupa sumo pfupi kubva pazvikamu zvitatu: anatomical chimiro, kuongororwa kwekiriniki uye nzira dzekurapa!
I.Anatomy
Iyo styloid process yeradius ine nhete, isina kudzika sulcus yakafukidzwa nedorsal carpal ligament inoumba fibrous sheath yebhoni. Iyo abductor pollicis longus tendon uye extensor pollicis brevis tendon inopfuura nemusheti iyi uye peta pakona uye inogumira pazasi pekutanga metacarpal bone uye hwaro hweiyo proximal phalanx yechigunwe, zvichiteerana (Mufananidzo 1). Apo tendon inotsvedza, kune simba guru rekukwevera, kunyanya kana wrist ulnar kutsauka kana kufamba kwechigunwe, iyo fold angle inowedzera, kuwedzera kupesana pakati petendon uye sheath wall. Mushure menguva refu inodzokororwa kusingaperi kukurudzirwa, iyo synovium inopa shanduko yekuzvimba senge edema uye hyperplasia, zvichikonzera kukora, kunamatira kana kutetepa kwetendon uye sheath wall, zvichikonzera kuratidzwa kwekiriniki ye stenosis tenosynovitis.
Fig.1 Anatomical diagram ye styloid process yeradius
II.Kuongororwa kwekiriniki
1.Nhoroondo yezvokurapa inowanzoitika muzera repakati-kati, vashandi vemaoko, uye inowanikwa kune vakadzi; Kutanga kunonoka, asi zviratidzo zvinogona kuitika kamwe kamwe.
2.Signs: marwadzo emunharaunda mumutambo we styloid we radius, iyo inogona kupenya kuruoko neruoko, kushaya simba kwechigunwe, kuwedzera kwegumbo, kuwedzera kwezviratidzo apo chigunwe chekuwedzera uye wrist ulnar kutsauka; Magunduru anorarika anogona kunzwisiswa pamaitiro echimiro cheradius, akafanana nebony eminence, ane hunyoro hwakajeka.
3.Muedzo waFinkelstein (kureva kuti, fist ulnar deviation test) yakanaka (sezvinoratidzwa mumufananidzo 2), chigunwe chinotenderedzwa uye chakabatwa muchanza, wrist yeurnar yakatsauka, uye marwadzo ari paradius styloid process anowedzera.
4.Kuongorora kwekubatsira: X-ray kana ruvara rwe ultrasound kuongororwa inogona kuitwa kana zvichidiwa kuti isimbise kana pane mapfupa asina kunaka kana synovitis. The Guidelines for the Multidisciplinary Treatment of Styloid Stenosis Tenosynovitis of the Radius Cherechedza kuti kumwe kuongorora kwepanyama kunodiwa kusiyanisa pakati pe osteoarthritis, kusagadzikana kwebazi repamusoro re radial nerve, uye forearm cruciate syndrome panguva yekuongororwa.
III.Kurapwa
Conservative therapyLocal immobilization therapy: Mukutanga kwekutanga, varwere vanogona kushandisa kunze kwekugadzirisa bhandi kuti vasafambisa nhengo yakakanganiswa kuderedza zviitiko zvemunharaunda uye kubvisa kukwesha kwetendon mu tendon sheath kuti vawane chinangwa chekurapa. Zvisinei, kushaya simba kunogona kusava nechokwadi chokuti gumbo rakakanganiswa riri panzvimbo, uye kusununguka kwenguva refu kunogona kukonzera kuoma kwekufamba kwenguva refu. Kunyangwe immobilization-yakabatsira mamwe marapirwo ari empirically anoshandiswa mukiriniki kudzidzira, kushanda kwekurapa kunoramba kuine nharo.
Local occlusion therapy: Seyakasarudzwa kuchengetedza kurapwa kwekiriniki kurapwa, yemunharaunda occlusion therapy inoreva intrathecal jekiseni panzvimbo yemarwadzo emunharaunda kuti ibudirire chinangwa chemunharaunda anti-inflammatory. Occlusive therapy inogona kupinza zvinodhaka munzvimbo inorwadza, joint sheath sac, nerve trunk nezvimwe zvikamu, izvo zvinogona kuderedza kuzvimba uye kubvisa marwadzo uye kubvisa spasms munguva pfupi, uye kuita basa guru mukurapa kwezvironda zvepanzvimbo. Mushonga wacho unosanganisira zvikuru triamcinolone acetonide uye lidocaine hydrochloride. Majekiseni eSodium hyaluronate anogonawo kushandiswa. Nekudaro, mahormone anogona kunge aine matambudziko akadai sekurwadziwa kwejekiseni, ganda remukati pigmentation, local subcutaneous tishu atrophy, symptomatic radial nerve kukuvara, uye yakakwira yeropa glucose. Iyo huru contraindications ndeye mahormone allergy, vane pamuviri uye vanoyamwisa varwere. Sodium hyaluronate inogona kunge yakachengeteka uye inogona kudzivirira mavanga ekunamatira kutenderedza tendon uye kukurudzira kuporesa tendon. Chirwere chechipatara che occlusive therapy chiri pachena, asi kune mishumo yekliniki yeminwe necrosis inokonzerwa nejekiseni risina kunaka remunharaunda (Mufananidzo 3).
Fig.3 Kuvharirwa kwechikamu kunotungamirira kune necrosis yeminwe yeminwe yezvigunwe: A. Ganda reruoko rinoputika, uye B, C. Chikamu chepakati chemunwe wechiratidzo chiri kure kure, uye zvigunwe zviri necrosis.
Kuchengetedza kweocclusive therapy mukurapa radius styloid stenosis tenosynovitis: 1) Nzvimbo yacho yakarurama, uye sirinji inofanira kubviswa isati yabaya mushonga kuti uone kuti jekiseni rejekiseni haripindi mumudziyo weropa; 2) Immobilization yakakodzera yegumbo rakakanganiswa kuti udzivise kushanda nguva isati yakwana; 3) Mushure mejekiseni rehomoni yekudzivirira, pane kazhinji madhigirii akasiyana ekurwadziwa, kuzvimba, uye kunyange kuwedzera kwemarwadzo, kazhinji kunyangarika mumazuva 2 ~ 3, kana marwadzo emunwe uye ruvara ruchionekwa, antispasmodic uye anticoagulant therapy inofanira kupiwa nokukurumidza, uye angiography inofanira kuitwa kuti iite chirwere chakajeka kana zvichibvira, uye kuongorora kwevascular kunofanira kuitwa, kuitira kuti usanonoka kana zvichibvira; 4) Hormonal contraindications yakadai sehypertension, chirwere cheshuga, chirwere chemwoyo, nezvimwewo, haifaniri kurapwa nekuvharwa kwenharaunda.
Shockwave: inochengetedza, isiri-invasive kurapa ine mukana wekugadzira simba kunze kwemuviri uye kuburitsa mhedzisiro munzvimbo dzakanangwa mukati memuviri pasina kukuvadza matishu akatenderedza. Iyo ine mhedzisiro yekusimudzira metabolism, kusimbisa ropa uye lymphatic kutenderera, kuvandudza hutano hwetishu, dredging akavharika capillaries, uye kusunungura majoini akapfava adhesions. Zvisinei, yakatanga kunonoka kurapwa kwe styloid stenosis tenosynovitis yeradius, uye mishumo yekutsvakurudza kwayo ishoma, uye zvidzidzo zvakakura zvakarongwa zvakarongwa zvichiri kudiwa kuti zvipe humwe uchapupu-huchapupu hwezvokurapa hunosimudzira kushandiswa kwayo mukurapa styloid stenosis tenosynovitis chirwere cheradius.
Acupuncture kurapwa: diki acupuncture kurapwa inzira yakavharwa yekuburitsa pakati pekuvhiya uye kusiri-kuvhiya kurapwa, kuburikidza nekudonhedza uye kupepeta kwezvironda zvemuno, adhesion inoburitswa, uye kusungwa kwevascular nerve bundle kunonyatso kusunungurwa, uye kutenderera kweropa kwematishu akapoteredzwa kunovandudzwa kuburikidza nebenign kukurudzira, kuputika kwekuputika, kuputika kwekuputika. chinangwa che anti-inflammatory uye analgesic.
Mushonga wechiChinese wechinyakare: Radial styloid stenosis tenosynovitis ndeyechikamu che "paralysis syndrome" mumushonga wenyika yaamai, uye chirwere chakavakirwa pakushomeka uye chiyero. Pamusana pekushanda kwenguva refu kwekubatana kwemaoko, kunyanya kunetseka, zvichiita kuti qi yemunharaunda uye kushaya ropa, izvi zvinonzi kushayikwa kwepakutanga; Nekuda kweiyo qi uye kushomeka kweropa, tsandanyama uye tsinga zvinorasika mukudya uye kutsvedza, uye nekuda kwekunzwa kwemhepo, kutonhora uye kunyorova, izvo zvinowedzera kuvharika kwe qi uye kuvhiyiwa kweropa, zvinoonekwa kuti kuzvimba kwenzvimbo uye marwadzo uye chiitiko zvinorambidzwa, uye kuunganidzwa kwe qi neropa kunowedzera kutyisa uye marwadzo emunharaunda. wrist joint uye yekutanga metacarpophalangeal joint yakawedzera mukiriniki, inova chiyero. Zvakaonekwa nekiriniki kuti moxibustion therapy, massage therapy, kurapwa kwekunze kwechivanhu Chinese mushonga uye acupuncture kurapwa kune mamwe makiriniki maitiro.
Kurapa kwekuvhiya: Kuvhiya kuchekwa kwe dorsal carpal ligament yeradius uye kubviswa zvishoma ndeimwe yemishonga ye stenosis tenosynovitis mu styloid process ye radius. Inokodzera varwere vane recurrent tenosynovitis yeradius styloid stenosis, iyo yave isingabatsiri mushure mekuvharwa kwenzvimbo dzakawanda uye mamwe marapirwo anochengetedza, uye zviratidzo zvakanyanya. Kunyanya kune varwere vane stenotic advanced tenosynovitis, inobvisa marwadzo akanyanya uye anoramba.
Kuvhiyiwa kwakananga: Nzira yekuvhiya yakajairwa ndeyekugadzira yakananga panzvimbo ine nyoro, kufumura yekutanga dorsal muscle septum, kucheka iyo yakakora tendon sheath, uye kusunungura tendon sheath kuitira kuti tendon iite kutsvedza zvakasununguka mukati metendon sheath. Kuvhiyiwa kwakananga kwakazaruka kunokurumidza kubudirira, asi kunotakura njodzi dzekuvhiya dzakadai sehutachiona, uye nekuda kwekubviswa kwakananga kwebhendi rekutsigira dorsal panguva yekuvhiyiwa, tendon dislocation uye kukanganisa kune radial nerve uye tsinga inogona kuitika.
1st septolysis: Iyi nzira yekuvhiya haicheki iyo yakakora tendon sheath, asi inobvisa ganglion cyst inowanikwa mu 1st extensor septum kana kucheka septum pakati abductor pollicis longus uye extensor pollicis brevis kusunungura 1st dorsal extensor septum. Iyi nzira yakafanana nekuvhiyiwa kwakananga kwakananga, nemusiyano mukuru ndewekuti mushure mekucheka bhendi rekutsigira extensor, tendon sheath inosunungurwa uye tendon sheath inobviswa panzvimbo yekucheka kwetendon sheath yakakora. Kunyange zvazvo tendon subluxation inogona kunge iripo mune iyi nzira, inodzivirira 1st dorsal extensor septum uye ine yakakwirira yenguva yakareba yehutano hwekugadzikana kwetendon pane kubviswa zvakananga kwetendon sheath. Kukanganisa kweiyi nzira kunonyanya kukonzerwa nekuti iyo yakakora tendon sheath haina kubviswa, uye yakakora tendon sheath inogona kuramba ichizvimba, edema, uye kupesana netendon kuchaita kuti chirwere chidzoke.
Arthroscopic osteofibrous duct augmentation: kurapwa kwearthroscopic kune zvakanakira kusanyanya kukuvadzwa, kupfupika kwekurapa kutenderera, kuchengetedzwa kwepamusoro, matambudziko mashoma uye kukurumidza kupora, uye mukana mukuru ndewekuti bhandi rekutsigira rinowedzera harina kucheneswa, uye hapazovi netendon dislocation. Zvisinei, kuchine kukakavara, uye dzimwe nyanzvi dzinotenda kuti kuvhiyiwa kweArthroscopic kunodhura uye kunopedza nguva, uye zvakanakira pakuvhiyiwa kwakananga hakusi pachena zvakakwana. Naizvozvo, kurapwa kwearthroscopic hakuwanzo kusarudzwa neruzhinji rwevanachiremba nevarwere.
Nguva yekutumira: Oct-29-2024
