摘要
目的探讨闭合环线切割手术治疗狭窄性腱鞘炎的临床疗效。方法2014年1月至2016年10月泰山医学院附属莱芜医院骨二科狭窄性腱鞘炎患者84例，按不同手术方法随机分成两组。手术切开组（42例）于掌指关节横纹近侧做切口，显露并切断腱鞘。环线切割组（42例）在超声引导下进行，分别从腱鞘的深层及浅层穿线，形成环套切断腱鞘，松解屈肌腱。术前及术后1、4周测定疼痛强度视觉类比评分（VAS），术后3个月综合疗效评定。结果两组患者术后1周后疼痛全部缓解，手术切开组治疗前及术后1周和4周后VAS评分分别为（7．0±1．3）、（5．2±1．6）、（2．8±1．1）分，相互之间比较差异均有统计学意义（均P〈0．05）；环线切割组患者治疗前后的VAS评分分别为（7．1±1．4）、（2．7±1．3）、（0．6±0．2）分，治疗前与治疗后1周和4周之间比较差异有统计学意义（P〈0．05），两组间术后1周和4周后之间比较差异有统计学意义（P〈0．05）。术后3个月两组综合疗效比较差异无统计学意义（P〉0．05）。两组术后均无感染、愈合不良及血管、神经损伤等并发症发生。结论超声引导下的环线切割手术治疗狭窄性腱鞘炎具有操作简便、安全有效、微创、易于推广等优点，达到与手术切开相同的疗效。
Objective To investigate the percutaneously looped thread transection for treatment of stenosing tenosynovitis and evaluate its treatment outcome. Methods From January 2014 to October 2016, Eighty-four patients with stenosing tenosynovitis were randomly divided into the open decompressionand group （42 cases） and percutaneously looped thread transection group （ 42 cases ） in Department of Orthopedics, Affiliated Laiwu Hospital of Taishan Medical College. Incision near the digit horizontal stripes, tendon sheath were cut off in the open decompressionand group. Percutaneously looped thread transection was under the guidance of ultrasound, threading from the deep and shallow transverse tendon sheath, respectively, forming loops to cut off and decompressed the flexor tendon. Visual analog scale（VAS） was used to evaluate the extent of pain before the operation and 1 or 4 weeks after the operation, the comprehensive curative effect were evaluated 3 months after the operation. Results In the two groups pain was alleviated. The VAS improved from （7. 0 ± 1.3） prior operation to（5.2 ± 1.6） and （2. 8 ± 1.1 ） 1 week and 4 weeks after the operation in the open decompressionand group , respectively. The difference before and after the operation was significant（ P 〈 0. 05 ）. The VAS improved from （ 7.1 ± 1.4 ） prior operation to （ 2. 7 ± 1.3 ） and （0. 6 ± 0. 2 ） 1 week and 4 weeks after the operation in the percutaneously looped thread transection group, respectively. The difference before and after the operation was significant（ P 〈 0. 05 ）. The difference of VAS scores between two groups at 1 week and 4 weeks after the operation were different （ P 〈 0.05 ）. The difference of the comprehensive curative effect between two groups at 3 months after the operation were not different（ P 〉 0. 05 ）. There were no infection, poor healing, blood vessel and nerve damage after operation in both two groups. Conclusion Percutaneously looped thread transaction under ultrasound for the surgical treatment of stenosing tenosynovitis has less trauma and rapid recovery. It has such advantage as being effective, simple , and reach the same effects as the open decompression surgery.
出处
《中华医学杂志》
CAS
CSCD
北大核心
2017年第37期2923-2927,共5页
National Medical Journal of China
关键词
腱鞘炎
疼痛
超声检查
外科手术
最小侵入性
Tenosynovitis
Pain
Ultrasonography
Surgical procedures, minimally invasive
