I-Styloid stenosis tenosynovitis ukuvuvukala kwe-aseptic okubangelwa ubuhlungu nokuvuvukala kwe-abductor pollicis longus kanye ne-extensor pollicis brevis tendons emgodleni we-dorsal carpal kunqubo ye-radial styloid. Izimpawu ziba zimbi ngokunwetshwa kwesithupha kanye nokuchezuka kwesilinganiso. Lesi sifo sabikwa okokuqala ngudokotela ohlinzayo waseSwitzerland u-de Quervain ngo-1895, ngakho-ke i-radial styloid stenosis tenosynovitis yaziwa nangokuthi isifo sika-Quervain.
Lesi sifo sivame kakhulu kubantu abenza imisebenzi eminingi yesandla nesandla somunwe, futhi saziwa nangokuthi “isandla sikamama” kanye “nomunwe wegeyimu”. Ngokuthuthuka kwe-Intanethi, isibalo sabantu abathintekayo yilesi sifo siyakhula futhi sibancane. Ngakho kanjani ukuxilonga nokwelapha lesi sifo? Okulandelayo kuzokunikeza isingeniso esifushane esivela ezicini ezintathu: isakhiwo se-anatomical, ukuxilongwa komtholampilo kanye nezindlela zokwelashwa!
I.Anatomy
Inqubo yesitayela yerediyasi ine-sulcus ewumngcingo, engashoni embozwe umsipha we-carpal ongemuva owakha umgodla we-fibrous of bony. I-abductor pollicis longus tendon kanye ne-extensor pollicis brevis tendon idlula kulo mgodla futhi isonge nge-engeli futhi iphele phansi kwethambo lokuqala le-metacarpal kanye nesisekelo se-phalanx eseduze yesithupha, ngokulandelana (Umfanekiso 1). Lapho i-tendon islayida, kuba namandla amakhulu okungqubuzana, ikakhulukazi lapho ukuchezuka kwe-ulnar yesandla noma ukunyakaza kwesithupha, i-engeli egoqekayo iyanda, okwandisa ukungqubuzana phakathi kwethenda kanye nodonga lweshethi. Ngemuva kokuvuselela okungapheli okuphindaphindiwe isikhathi eside, i-synovium iveza izinguquko ezivuthayo ezifana ne-edema ne-hyperplasia, okubangela ukuqina, ukunamathela noma ukuncipha kwe-tendon nodonga lwe-sheath, okuholela ekubonakalisweni kwemitholampilo ye-stenosis tenosynovitis.
Fig.1 Umdwebo we-anatomical wenqubo ye-styloid yerediyasi
II.Ukuxilongwa komtholampilo
1.Umlando wezokwelashwa uvame kakhulu kubantu abaneminyaka ephakathi, abasebenza ngezandla, futhi uvame kakhulu kwabesifazane; Ukuqala kuhamba kancane, kodwa izimpawu zingavela ngokuzumayo.
I-2.Izimpawu: ubuhlungu bendawo enqubweni ye-styloid ye-radius, engakhipha esandleni nasesandleni, ubuthakathaka besithupha, ukunwetshwa kwesithupha okulinganiselwe, ukubhebhetheka kwezimpawu lapho ukunwetshwa kwesithupha kanye nokuphambuka kwe-ulnar yesihlakala; Amaqhuqhuva aphathekayo angase abonakale enqubweni yesitayela serediyasi, afane nokugqama kwethambo, anokuthamba okuphawuliwe.
3.Ukuhlolwa kukaFinkelstein (okungukuthi, ukuhlolwa kokuchezuka kwenqindi kwe-ulnar) kuhle (njengoba kuboniswe kuMfanekiso 2), isithupha siyagobeka futhi sibanjwe entendeni yesandla, isihlakala se-ulnar siyachezuka, futhi ubuhlungu benqubo yesitayela se-radius buyaqina.
I-4.Ukuhlolwa okusizayo: Ukuhlolwa kwe-X-ray noma i-ultrasound yombala kungenziwa uma kunesidingo ukuze kuqinisekiswe ukuthi kukhona ukungahambi kahle kwamathambo noma i-synovitis. Iziqondiso Zokwelashwa Okuningi Kwe-Styloid Stenosis Tenosynovitis Ye-Radius Qaphela ukuthi ezinye izivivinyo zomzimba ziyadingeka ukuze kuhlukaniswe phakathi kwe-osteoarthritis, ukuphazamiseka kwegatsha elingaphezulu le-radial nerve, kanye nesifo se-forearm cruciate ngesikhathi sokuxilongwa.
III.Ukwelashwa
Ukwelapha ngokulondoloza imveloUkwelashwa kokuvinjelwa kwendawo: Esigabeni sokuqala, iziguli zingasebenzisa ibrace yokulungisa yangaphandle ukuze zenze isitho esithintekile singanyakazi ukuze kuncishiswe imisebenzi yasendaweni futhi kukhululeke ukungqubuzana kwe-tendon emgodleni we-tendon ukuze kuzuzwe umgomo wokwelapha. Kodwa-ke, ukuvinjelwa kungase kungaqinisekisi ukuthi isitho esithintekile sikhona, futhi ukungakwazi ukuhamba isikhathi eside kungase kubangele ukuqina kokunyakaza kwesikhathi eside. Nakuba ezinye izindlela zokwelapha ezisizwa yi-immobilization zisetshenziswa ngokunamandla emisebenzini yomtholampilo, ukusebenza kahle kokwelashwa kusalokhu kuyimpikiswano.
Ukwelashwa kwe-occlusion therapy: Njengendlela yokwelashwa elondolozayo ekhethwayo yokwelashwa komtholampilo, ukwelashwa kwe-occlusion therapy kubhekisela kumjovo we-intrathecal endaweni yezinhlungu zendawo ukuze kuzuzwe inhloso yendawo yokulwa nokuvuvukala. I-Occlusive therapy ingajova izidakamizwa endaweni ebuhlungu, isikhwama se-joint sheath, i-nerve trunk nezinye izingxenye, ezinganciphisa ukuvuvukala futhi zidambise ubuhlungu futhi zikhulule ama-spasms ngesikhathi esifushane, futhi zidlale indima enkulu kakhulu ekwelapheni izilonda zendawo. Ukwelashwa kuqukethe ikakhulukazi i-triamcinolone acetonide ne-lidocaine hydrochloride. Imijovo ye-sodium hyaluronate nayo ingasetshenziswa. Kodwa-ke, amahomoni angase abe nezinkinga ezinjengobuhlungu bangemva kokujova, umbala wesikhumba wasendaweni, i-atrophy yezicubu ezingaphansi kwesikhumba, ukulimala kwenzwa ye-radial eyizimpawu, kanye nokwenyuka kweglucose yegazi. I-contraindication eyinhloko i-hormone yokungezwani komzimba, iziguli ezikhulelwe nezincelisayo. I-sodium hyaluronate ingase iphephe kakhudlwana futhi ingavimbela ukonakala kokunamathela eduze kwe-tendon futhi ikhuthaze ukuphulukiswa kwe-tendon. Umphumela womtholampilo we-occlusive therapy usobala, kodwa kunemibiko yomtholampilo ye-necrosis yomunwe ebangelwa umjovo wendawo ongafanele (Umfanekiso 3).
Fig.3 Ukuvaleka kancane kuholela ku-necrosis yeminwe yeminwe yenkomba: A. Isikhumba sesandla sinamabala, futhi B, C. Ingxenye ephakathi yomunwe wokukhomba ikude, kanti iminwe i-necrosis.
Izinyathelo zokuphepha zokwelapha i-occlusive ekwelapheni i-radius styloid stenosis tenosynovitis: 1) Isikhundla sinembile, futhi isipetu kufanele sihoxiswe ngaphambi kokujova umuthi ukuze kuqinisekiswe ukuthi inaliti yomjovo ayingeni emkhunjini wegazi; 2) Ukuvinjelwa okufanele kwesitho esithintekile ukuze kugwenywe ukuzikhandla ngaphambi kwesikhathi; I-3) Ngemuva komjovo we-hormone occlusion, kuvame ukuba namazinga ahlukene obuhlungu, ukuvuvukala, ngisho nokwanda kobuhlungu, okuvame ukunyamalala ezinsukwini ezingu-2-3, uma kubonakala ubuhlungu beminwe kanye ne-pallor, ukwelashwa kwe-antispasmodic kanye ne-anticoagulant kufanele kunikezwe ngokushesha, futhi i-angiography kufanele yenziwe ukuze kutholakale ukuxilongwa okucacile uma kungenzeka, futhi ukuhlolwa kwemithambo kufanele kwenziwe, ukuze kungabambezeleki ngokushesha ngangokunokwenzeka; I-4) Ukuphikisana kwe-Hormonal njenge-hypertension, isifo sikashukela, isifo senhliziyo, njll, akufanele kuphathwe ngokuvaleka kwendawo.
I-Shockwave: iyindlela yokwelapha elondolozayo, engahlaseli enenzuzo yokukhiqiza amandla ngaphandle komzimba futhi ikhiqize imiphumela ezindaweni ezihlosiwe ekujuleni komzimba ngaphandle kokulimaza izicubu ezizungezile. Kunomphumela wokuthuthukisa i-metabolism, ukuqinisa ukujikeleza kwegazi nokujikeleza kwe-lymphatic, ukuthuthukisa umsoco wezicubu, ukudonsa ama-capillary avinjelwe, nokukhulula ukunamathela kwezicubu ezithambile ezihlangene. Kodwa-ke, iqale sekwephuzile ekwelapheni i-styloid stenosis tenosynovitis ye-radius, futhi imibiko yayo yocwaningo imbalwa uma kuqhathaniswa, futhi izifundo ezinkulu ezilawulwa ngokungahleliwe zisadingeka ukuze kuhlinzekwe ubufakazi obengeziwe bezokwelapha obusekelwe ebufakazini ukuze kuthuthukiswe ukusetshenziswa kwayo ekwelapheni isifo se-styloid stenosis tenosynovitis se-radius.
Ukwelashwa kwe-acupuncture: Ukwelashwa kwe-acupuncture encane kuyindlela yokukhululwa evaliwe phakathi kokwelashwa okuhlinzayo kanye nokwelashwa okungahlinzeki, ngokudonsa kanye nokuxebuka kwezilonda zendawo, ukunamathela kukhishwa, futhi ukuboshwa kwe-vascular nerve bundle kukhululwa ngokuphumelelayo, futhi ukujikeleza kwegazi kwezicubu ezizungezile kuthuthukiswa ngokuvuselela i-benign, ukuvuvukala nokuvuvukala. Inhloso ye-anti-inflammatory and analgesic.
Umuthi wendabuko waseShayina: I-Radial styloid stenosis tenosynovitis iyingxenye yesigaba "se-paralysis syndrome" emithi ye-motherland, futhi lesi sifo sisekelwe ekuntulekeni kanye nezinga. Ngenxa yomsebenzi wesikhathi eside we-wrist joint, ukucindezeleka ngokweqile, okuholela ekuntuleni kwe-qi yendawo kanye negazi, lokhu kubizwa ngokuthi ukuntula kokuqala; Ngenxa yokuntuleka kwe-qi kanye negazi lendawo, imisipha nemithambo ilahlekile ekondlekeni nasekusheleleni, futhi ngenxa yokuzwa komoya, amakhaza kanye nomswakama, okwandisa ukuvinjelwa kwe-qi kanye nokusebenza kwegazi, kubonakala ukuthi ukuvuvukala kwendawo kanye nobuhlungu kanye nomsebenzi kuvinjelwe, futhi ukuqoqwa kwe-qi negazi kutholakala kubi kakhulu futhi ubuhlungu bendawo buba nzima nakakhulu. ilunga lesihlakala kanye nelunga lokuqala le-metacarpophalangeal libhebhetheka emtholampilo, okuyindinganiso. Ngokomtholampilo kwatholakala ukuthi ukwelashwa kwe-moxibustion, ukubhucungwa, ukwelashwa kwangaphandle komuthi wendabuko waseShayina kanye nokwelashwa kwe-acupuncture kunemiphumela ethile yomtholampilo.
Ukwelashwa ngokuhlinzwa: Ukusikwa komgogodla we-carpal ligament ye-radius kanye nokusika okulinganiselwe kungenye yezindlela zokwelapha i-stenosis tenosynovitis kunqubo ye-styloid ye-radius. Ifanele iziguli ezine-tenosynovitis ephindaphindayo ye-radius styloid stenosis, engazange isebenze ngemva kokuvaleka okuningi kwendawo kanye nezinye izindlela zokwelapha ezilondolozayo, futhi izimpawu zinzima. Ikakhulukazi ezigulini ezine-stenotic advanced tenosynovitis, ikhulula ubuhlungu obunzima futhi obuphikisayo.
Ukuhlinzwa okuqondile okuvulekile: Indlela evamile yokuhlinza iwukwenza ukusika okuqondile endaweni yethenda, ukuveza i-septum yokuqala ye-dorsal muscle, ukusika i-tendon sheath, futhi ukhulule i-tendon sheath ukuze i-tendon ikwazi ukuslayida ngokukhululekile ngaphakathi kwe-tendon sheath. Ukuhlinzwa okuqondile okuvulekile kuyashesha ukufeza, kodwa kuthwala uchungechunge lwezingozi zokuhlinzwa ezifana nokutheleleka, futhi ngenxa yokususwa okuqondile kwebhande lokusekela i-dorsal ngesikhathi sokuhlinzwa, ukukhishwa kwe-tendon nokulimala kwe-radial nerve kanye nomthambo kungase kwenzeke.
I-1st septolysis: Le ndlela yokuhlinza ayinqamuli i-tendon sheath ejiyile, kodwa isusa i-cyst ganglion etholakala ku-1st extensor septum noma isika i-septum phakathi kwe-abductor pollicis longus ne-extensor pollicis brevis ukuze ikhulule i-1st dorsal extensor septum. Le ndlela ifana nokuhlinzwa okuqondile okuvulekile, umehluko omkhulu ukuthi ngemva kokusika ibhande lokusekela i-extensor, i-tendon sheath iyakhululwa futhi i-tendon sheath isusiwe esikhundleni sokusikwa kwe-tendon sheath eqinile. Nakuba i-tendon subluxation ingase ibe khona kule ndlela, ivikela i-1st dorsal extensor septum futhi inokusebenza okuphakeme kwesikhathi eside kokuzinza kwe-tendon kunokukhishwa okuqondile kwe-tendon sheath. Ukungalungi kwale ndlela kubangelwa ikakhulukazi ukuthi i-tendon sheath eqinile ayisuswanga, futhi i-tendon sheath eqinile ingase ibe nokuvuvukala, i-edema, kanye nokungqubuzana ne-tendon kuzoholela ekuphindeni kwesifo.
I-Arthroscopic osteofibrous duct augmentation: ukwelashwa kwe-arthroscopic kunezinzuzo zokuhlukumezeka okuncane, umjikelezo wezokwelapha omfushane, ukuphepha okuphezulu, izinkinga ezimbalwa kanye nokululama ngokushesha, futhi inzuzo enkulu kakhulu ukuthi ibhande lokusekela i-extensor alifakwanga, futhi ngeke kube khona ukuchithwa kwe-tendon. Nokho, kusenempikiswano, futhi ezinye izazi zikholelwa ukuthi ukuhlinzwa kwe-arthroscopic kuyabiza futhi kudla isikhathi, futhi izinzuzo zako phezu kokuhlinzwa okuqondile okuqondile azibonakali ngokwanele. Ngakho-ke, ukwelashwa kwe-arthroscopic ngokuvamile akukhethiwe iningi lodokotela neziguli.
Isikhathi sokuthumela: Oct-29-2024
