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    小针刀治疗拇指狭窄性腱鞘炎197例

    出处:论文网
    时间:2019-09-11

    小针刀治疗拇指狭窄性腱鞘炎197例

      【中图分类号】R248.3 【文献标识码】A 【文章编号】1005-0019(2019)15--02

      拇指狭窄性腱鞘炎又名“弹响拇”,可发生于不同年龄,多见于女性手工劳动者。患者由于患指关节周围疼痛和手指屈伸活动受限而给工作和生活带来诸多不便,作者自2009.1~2018.1采用小针刀治疗拇指狭窄性腱鞘炎197例,因其损伤小、操作简单、疗效肯定,颇受患者欢迎。现报道如下:

      1 临床资料

      本组病例197例,其中男22例,女175例;年龄最大者79岁,最小28岁。病程最长者6年,最短者3个月。临床表现有拇指掌指关节晨起发僵、疼痛,缓慢活动后可消失或减轻症状。病程长的患者疼痛明显,患指不敢活动。体检时可在远侧掌横纹处扪及黄豆大小的痛性结节,屈伸患指结节可随屈肌腱上下移动,并出现弹拨现象。

      2 治疗方法

      术者仔细检查触摸确定腱鞘绞锁、弹响处,定位后用龙胆紫在病变处定一标记。将患指平放于手术台面上,掌心向上,严格消毒、铺无菌洞巾,用2%利多卡因注射液1~2ml局麻。進刀点在掌指横纹中央,术者左手拇、示指分压标记处两侧,右手持针,用小针刀垂直90°刺入皮肤直至腱鞘,保持在腱鞘的正中央,不可左右偏斜,以免伤及刀下的组织,刀口线沿肌腱纵轴方向,沿腱鞘纵形切增厚的腱鞘3~5刀,切割长度一般为1~1.5cm,此时术者会感觉切断坚韧组织的“喳喳”声。嘱患者屈伸患指,如弹响消失,绞锁解除,患指屈伸自如,即可拔出针刀。否则可继续用针刀再切弹响处增厚的腱鞘直至弹响消失或患指屈伸自如。术毕用创可贴敷于针眼处即可。嘱患者术后48h内患指针眼避免水浸泡以针防感染,48h后自行屈伸患指锻炼功能,防止粘连。

      3 疗效分析

      3.1 疗效标准 按国家中医管理局制定的统一标准评定[1],患指掌侧无肿痛,无压痛,自主伸屈活动正常,无弹响声及绞锁现象,为治愈;患指局部肿痛减轻,患指活动时有轻微疼痛,或有轻微弹响声,但无绞锁现象,为好转;临床症状无改善,为无效。

      3.2 治疗结果 本组病例随访时间为1年,经小针刀治疗,1次治愈179例(占90.86%),1次好转18例(占9.14%),经再次松解治愈,无无效者。

      4 典型病例

      患者刘××,女,56岁,家庭主妇。于2016年9月26日来诊,主诉右手拇指疼痛不适,不能屈伸,体检见右手掌指关节处有压疼且可扪及小硬结。曾在本村卫生室诊治,给予“消炎止痛,活血化瘀”等药物治疗,效果不理想。来我院就诊后给予小针刀治疗,随访1年,未见复发,痊愈。

      5 讨论

      拇指狭窄性腱鞘炎可发生于任何年龄,以40岁以上的中老年人,特别是女性患者居多。病因主要是拇指在掌指关节处两侧的籽骨与环状韧带(腱鞘滑车)形成一环形狭窄的骨纤维管道,手指不断屈伸使屈肌腱和腱鞘在狭窄的骨纤维管道内反复磨擦而发生慢性创伤性炎症,其环状韧带(腱鞘滑车)增厚,肌腱呈结节样肿胀,致使该处屈指肌腱的通道狭窄[2]。同时屈指肌腱也发生创伤性水肿,增厚的环状韧带成葫芦状,形成解剖学上的狭窄征。此时患指做伸曲活动会出现疼痛、弹响。而患指做屈伸活动,肌腱与腱鞘滑车之间的磨擦又加重了疼痛和局部的炎症反应,使腱鞘狭窄进一步加重,这样就成了一个恶性循环。采用针刀切割松解术,就是将增厚而狭窄的指屈肌腱鞘滑车纵行切开松解,消除了狭窄和弹响,从而改善了局部的血液循环,打破了恶性循环,消除患指屈伸活动时肌腱与腱鞘滑车之间的相互过度磨擦,因此可以消除炎症和由此产生的疼痛。采用小针刀疗法既能得到治疗及恢复功能的目的,不留瘢痕,而且方法简单、疗程短、痛苦小,不需住院,且安全可靠、费用低,减轻病人的经济负担,不延误病人工作,易被接受,适合于基层医疗单位广泛开展。

    小针刀治疗拇指狭窄性腱鞘炎197例

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