I-Styloid stenosis tenosynovitis ukuvuvukala okungenamagciwane okubangelwa ubuhlungu nokuvuvukala kwemisipha ye-abductor pollicis longus kanye ne-extensor pollicis brevis endaweni ye-dorsal carpal sheath enqubweni ye-radial styloid. Izimpawu ziya ziba zimbi kakhulu ngokwandiswa kwesithupha kanye nokuphambuka kwe-calimor. Lesi sifo sabikwa okokuqala ngudokotela ohlinzayo waseSwitzerland u-de Quervain ngo-1895, ngakho-ke i-radial styloid stenosis tenosynovitis yaziwa nangokuthi isifo sika-de Quervain.
Lesi sifo sivame kakhulu kubantu abenza imisebenzi yesandla neminwe yesundu njalo, futhi saziwa nangokuthi “isandla sikamama” kanye “nomunwe womdlalo”. Ngokuthuthuka kwe-inthanethi, inani labantu abathintekile yilesi sifo liyakhula futhi liba lincane. Ngakho-ke ungasithola kanjani futhi usiphathe kanjani lesi sifo? Okulandelayo kuzokunikeza isingeniso esifushane esivela ezicini ezintathu: isakhiwo somzimba, ukuxilongwa kwezokwelapha kanye nezindlela zokwelapha!
I. Ukwakheka Kwezinto Eziphilayo
Inqubo yesitayela se-radius ine-sulcus encane, engajulile embozwe yi-dorsal carpal ligament eyakha i-fibrous sheath yamathambo. I-abductor pollicis longus tendon kanye ne-extensor pollicis brevis tendon zidlula kulesi sheath bese zigoqa nge-engela bese ziphela phansi kwethambo lokuqala le-metacarpal kanye nesisekelo se-proximal phalanx yesithupha, ngokulandelana (Isithombe 1). Lapho i-tendon ishelela, kuba namandla amakhulu okungqubuzana, ikakhulukazi lapho ukuphambuka kwesinqe sesandla noma ukunyakaza kwesithupha, i-engela yokugoqa iyanda, okwandisa ukungqubuzana phakathi kwe-tendon nodonga lwe-sheath. Ngemva kokuvuselelwa okungapheli okuphindaphindiwe isikhathi eside, i-synovium iveza izinguquko zokuvuvukala ezifana ne-edema kanye ne-hyperplasia, okubangela ukuqina, ukunamathela noma ukuncishiswa kwe-tendon nodonga lwe-sheath, okuholela ekubonakalisweni kwezokwelapha kwe-stenosis tenosynovitis.
Umfanekiso 1 Umdwebo wokwakheka kwenqubo yesitayela serediyasi
II. Ukuxilongwa kwezokwelapha
1. Umlando wezokwelapha uvame kakhulu kubantu asebekhulile, abasebenza ngesandla, futhi uvame kakhulu kwabesifazane; Ukuqala kancane, kodwa izimpawu zingavela ngokuzumayo.
2. Izimpawu: ubuhlungu bendawo enqubweni ye-styloid ye-radius, engaphuma esandleni nasengalo, ubuthakathaka besithupha, ukunwetshwa kwesithupha okulinganiselwe, ukwanda kwezimpawu lapho kunwetshwa isithupha kanye nokuphambuka kwesihlakala; Amaqhubu azwakalayo angase azwakale enqubweni ye-styloid ye-radius, efana nokuvelela kwamathambo, nokuthamba okuphawulekayo.
3.Ukuhlolwa kukaFinkelstein (okungukuthi, ukuhlolwa kokuphambuka kwe-ulnar fist) kuqinisekile (njengoba kuboniswe kuMfanekiso 2), isithupha siyagoba futhi sibanjwe entendeni yesandla, isihlakala se-ulnar siyaphambuka, futhi ubuhlungu enqubweni ye-radius styloid buyanda.
4. Ukuhlolwa okusizayo: Ukuhlolwa kwe-X-ray noma i-ultrasound yombala kungenziwa uma kudingeka ukuqinisekisa ukuthi kukhona ukukhubazeka kwamathambo noma i-synovitis. Iziqondiso Zokwelashwa Kwe-Styloid Stenosis Ngezindlela Ezihlukahlukene I-Tenosynovitis Ye-Radius Qaphela ukuthi kudingeka ezinye izivivinyo zomzimba ukuze kuhlukaniswe phakathi kwe-osteoarthritis, ukuphazamiseka kwegatsha elingaphezulu le-radial nerve, kanye ne-forearm cruciate syndrome ngesikhathi sokuxilongwa.
III. Ukwelashwa
Ukwelashwa okulondolozayo Ukwelashwa kwendawo yokuvimba ukunyakaza: Esigabeni sokuqala, iziguli zingasebenzisa i-external fixation brace ukuvimba umlenze othintekile ukuze kuncishiswe imisebenzi yendawo futhi kunciphise ukungqubuzana kwe-tendon esikhumbeni se-tendon ukuze kufezwe umgomo wokwelashwa. Kodwa-ke, ukuvimba ukunyakaza kungase kungaqinisekisi ukuthi umlenze othintekile ukhona, futhi ukuvimbela ukunyakaza isikhathi eside kungabangela ukuqina kokunyakaza isikhathi eside. Nakuba ezinye izindlela zokwelapha ezisizwa ukuvimba ukunyakaza zisetshenziswa ngokombono emitholampilo, ukusebenza kahle kokwelashwa kusalokhu kuyimpikiswano.
Ukwelashwa kokuvalwa kwendawo: Njengokwelashwa okulondolozwayo okuthandwayo kokwelashwa kwezokwelapha, ukwelashwa kokuvalwa kwendawo kubhekisela ekufakweni kwe-intrathecal endaweni yobuhlungu bendawo ukuze kufezwe inhloso yokulwa nokuvuvukala kwendawo. Ukwelashwa kokuvalwa kungafakwa izidakamizwa endaweni ebuhlungu, esikhwameni se-sheath samalunga, esiqwini semizwa nakwezinye izingxenye, okunganciphisa ukuvuvukala nokuqeda ubuhlungu nokuqeda ukuqaqamba ngesikhathi esifushane, futhi kudlale indima enkulu ekwelapheni izilonda zendawo. Ukwelashwa kuqukethe ikakhulukazi i-triamcinolone acetonide kanye ne-lidocaine hydrochloride. Imijovo ye-sodium hyaluronate nayo ingasetshenziswa. Kodwa-ke, ama-hormone angase abe nezinkinga ezifana nobuhlungu obungemva komjovo, umbala wesikhumba wendawo, ukuncipha kwezicubu ezingaphansi komhlaba zendawo, ukulimala kwemizwa ye-radial okubonakalayo, kanye noshukela wegazi ophakeme. Iziphazamiso eziyinhloko ukungezwani nama-hormone, iziguli ezikhulelwe nezincelisayo. I-sodium hyaluronate ingaba iphephile futhi ingavimbela izibazi zokunamathela ezizungeze i-tendon futhi ikhuthaze ukuphulukiswa kwe-tendon. Umphumela wezokwelapha wokwelashwa kokuvalwa usobala, kodwa kunemibiko yezokwelapha ye-necrosis yeminwe ebangelwa umjovo wendawo ongafanele (Isithombe 3).
Isithombe 3 Ukuvaleka okuyingxenye kuholela ekuqhekekeni kweminwe yeminwe yokukhomba: A. Isikhumba sesandla sinamabala, kanti u-B, u-C. Ingxenye ephakathi yomunwe wokukhomba ikude kakhulu, kanti iminwe yeminwe iyi-necrosis
Izinyathelo Zokuqapha Zokwelapha Okungaqondile Ekwelapheni I-Radius Styloid Stenosis Tenosynovitis: 1) Indawo eqondile, futhi i-syringe kumele ihoxiswe ngaphambi kokufaka umuthi ukuqinisekisa ukuthi inaliti yomjovo ayingeni emthanjeni wegazi; 2) Ukuvimbela okufanele kwesitho esithintekile ukugwema ukuzikhandla ngaphambi kwesikhathi; 3) Ngemva komjovo wokuvaleka kwama-hormone, kuvame ukuba namazinga ahlukene obuhlungu, ukuvuvukala, ngisho nokwanda kobuhlungu, ngokuvamile kuyanyamalala ezinsukwini ezingu-2 ~ 3, uma kuvela ubuhlungu bomunwe kanye ne-pallor, ukwelashwa kwe-antispasmodic kanye ne-anticoagulant kufanele kunikezwe ngokushesha, futhi kufanele kwenziwe i-angiography ukuze kwenziwe ukuxilongwa okucacile uma kungenzeka, futhi ukuhlolwa kwemithambo yegazi kufanele kwenziwe ngokushesha okukhulu uma kudingeka, ukuze kungalibazisi isimo; 4) Iziphazamiso zama-hormone ezifana nomfutho wegazi ophakeme, isifo sikashukela, isifo senhliziyo, njll., akufanele ziphathwe ngokuvaleka kwendawo.
I-Shockwave: iyindlela yokwelapha elondolozayo, engahlaseli enenzuzo yokukhiqiza amandla ngaphandle komzimba futhi ikhiqize imiphumela ezindaweni eziqondiwe ngaphakathi emzimbeni ngaphandle kokulimaza izicubu ezizungezile. Inomthelela wokukhuthaza i-metabolism, ukuqinisa ukujikeleza kwegazi kanye ne-lymphatic, ukuthuthukisa ukondleka kwezicubu, ukuguguleka kwama-capillary avinjiwe, kanye nokukhulula ukunamathela kwezicubu ezithambile zamalunga. Kodwa-ke, yaqala sekwephuzile ekwelapheni i-styloid stenosis tenosynovitis ye-radius, futhi imibiko yayo yocwaningo imbalwa kakhulu, futhi izifundo ezinkulu ezilawulwa ngokungahleliwe zisadingeka ukuze kunikezwe ubufakazi obengeziwe bezokwelapha obusekelwe ebufakazini ukuze kukhuthazwe ukusetshenziswa kwayo ekwelapheni i-styloid stenosis tenosynovitis isifo se-radius.
Ukwelashwa nge-acupuncture: ukwelashwa nge-acupuncture encane kuyindlela yokukhulula evaliwe phakathi kokwelashwa ngokuhlinzwa kanye nokwelashwa okungekona ukuhlinzwa, ngokudonswa nokuhlubuka kwezilonda zendawo, ukunamathela kuyakhululwa, futhi ukubanjwa kwe-vascular nerve bundle kukhululeka ngempumelelo, futhi ukujikeleza kwegazi kwezicubu ezizungezile kuyathuthukiswa ngokukhuthaza okungenabungozi kwe-acupuncture, ukunciphisa ukuvuvukala, kanye nokufeza injongo yokulwa nokuvuvukala kanye nobuhlungu.
Imithi Yendabuko YamaShayina: I-Radial styloid stenosis tenosynovitis ingeyesigaba "se-paralysis syndrome" kwezokwelapha zezwe, futhi lesi sifo sisekelwe ekusweleni kanye nendinganiso. Ngenxa yomsebenzi wesikhathi eside welunga lesihlakala, ukucindezeleka ngokweqile, okuholela ekwehleni kwe-qi yendawo kanye nokuntuleka kwegazi, lokhu kubizwa ngokuthi ukuntuleka kokuqala; Ngenxa yokuntuleka kwe-qi yendawo kanye negazi, imisipha nemithambo yegazi ilahleka ekudleni nasekusheleleni, futhi ngenxa yokuzwa komoya, ukubanda kanye nomswakama, okwenza kube nzima ukuvaleka kwe-qi kanye nokusebenza kwegazi, kubonakala ukuthi ukuvuvukala kwendawo kanye nobuhlungu kanye nomsebenzi kunqunyelwe, futhi ukuqongelela kwe-qi negazi kubi kakhulu kanti ukuqaqamba kwendawo kubi kakhulu, ngakho-ke kutholakale ukuthi ubuhlungu belunga lesihlakala elihambayo kanye nelunga lokuqala le-metacarpophalangeal buyaqina emtholampilo, okuyindinganiso. Kwatholakala ngokwezokwelapha ukuthi ukwelashwa nge-moxibustion, ukwelashwa ngokubhucungwa, ukwelashwa kwangaphandle kwemithi yendabuko yamaShayina kanye nokwelashwa nge-acupuncture kunemiphumela ethile yezokwelapha.
Ukwelashwa ngokuhlinzwa: Ukuhlinzwa kokusika kwe-dorsal carpal ligament ye-radius kanye nokususwa okulinganiselwe kungenye yezindlela zokwelapha i-stenosis tenosynovitis enqubweni ye-styloid ye-radius. Ifanele iziguli ezine-tenosynovitis ephindaphindayo ye-radius styloid stenosis, ebingasebenzi kahle ngemva kokuvaleka okuningi kwendawo kanye nezinye izindlela zokwelapha ezilondolozayo, futhi izimpawu zinzima kakhulu. Ikakhulukazi ezigulini ezine-stenotic advanced tenosynovitis, iqeda ubuhlungu obukhulu nobungalawuleki.
Ukuhlinzwa okuvulekile ngqo: Indlela evamile yokuhlinzwa ukwenza ukusika okuqondile endaweni ethambile, ukuveza i-septum yokuqala yemisipha yangemuva, ukusika i-tendon sheath eqinisiwe, bese ukhulula i-tendon sheath ukuze i-tendon ishelele ngokukhululeka ngaphakathi kwe-tendon sheath. Ukuhlinzwa okuvulekile ngqo kuyashesha ukufeza, kodwa kuthwala uchungechunge lwezingozi zokuhlinzwa ezifana nokutheleleka, futhi ngenxa yokususwa ngqo kwebhande lokusekela i-dorsal ngesikhathi sokuhlinzwa, ukuhlukana kwe-tendon kanye nomonakalo we-radial nerve kanye ne-vein kungenzeka.
I-septolysis yokuqala: Le ndlela yokuhlinzwa ayinqumi i-tendon sheath eqinisiwe, kodwa isusa i-ganglion cyst etholakala ku-1st extensor septum noma inqume i-septum phakathi kwe-abductor pollicis longus kanye ne-extensor pollicis brevis ukuze kukhishwe i-1st dorsal extensor septum. Le ndlela ifana nokuhlinzwa okuvulekile okuqondile, umehluko omkhulu ukuthi ngemva kokusika i-extensor support band, i-tendon sheath iyakhishwa bese i-tendon sheath isuswa esikhundleni sokusika i-tendon sheath eqinisiwe. Nakuba i-tendon subluxation ingaba khona kule ndlela, ivikela i-1st dorsal extensor septum futhi inamandla aphezulu okuqina kwe-tendon kunokusikwa ngqo kwe-tendon sheath. Ububi bale ndlela bubangelwa kakhulu ukuthi i-tendon sheath eqinisiwe ayisuswa, futhi i-tendon sheath eqinisiwe ingase ibe nokuvuvukala, ukuvuvukala, kanye nokungqubuzana ne-tendon kuzoholela ekuphindeni kwesifo.
Ukwandiswa kwe-arthroscopic osteofibrous duct: ukwelashwa nge-arthroscopic kunezinzuzo zokuhlukumezeka okuncane, umjikelezo omfushane wokwelashwa, ukuphepha okuphezulu, izinkinga ezimbalwa kanye nokululama okusheshayo, futhi inzuzo enkulu ukuthi ibhande lokusekela le-extensor alihlikiwe, futhi ngeke kube nokuhlukana kwemisipha. Kodwa-ke, kusenempikiswano, futhi ezinye izazi zikholelwa ukuthi ukuhlinzwa nge-arthroscopic kuyabiza futhi kuthatha isikhathi, futhi izinzuzo zako ngaphezu kokuhlinzwa okuvulekile okuqondile azibonakali ngokwanele. Ngakho-ke, ukwelashwa nge-arthroscopic ngokuvamile akukhethwe iningi lodokotela neziguli.
Isikhathi sokuthunyelwe: Okthoba-29-2024
