肌骨超声引导下针刀治疗屈指肌腱狭窄性腱鞘炎的临床观察

Clinical Observation of Musculoskeletal Ultrasound Guided Needle-knife on the Flexor Tendon Stenosis Tenosynovitis

目的:评价超声定位下针刀治疗屈指肌腱狭窄性腱鞘炎的临床疗效,超声下测量并总结A1滑车形态及其位置,使该操作趋向精准化。方法:回顾2016年2月至2018年2月期间在北京中医药大学第三附属医院门诊患者,采用超声引导下针刀治疗屈指肌腱狭窄性腱鞘炎患者60例(69指),于术前、术后2周及术后1个月收集患指A1滑车厚度、Quinnell分级以及VAS评分值,并进行分析比较。同时于术前测量并标记A1滑车厚度、宽度、与掌横纹远端的距离及其与指动脉的距离。结果:术前后A1滑车厚度、Quinnell分级以及VAS评分分别行单因素重复测量方差分析,差异有统计学意义(P<0.01)。测得患指A1滑车平均厚度1.54mm,A1滑车平均宽度6.70mm,A1滑车近缘与掌横纹平均距离3.20mm,A1滑车中线距两侧指动脉的平均距离8.00mm.结论:肌骨超声引导下针刀治疗屈指肌腱狭窄性腱鞘炎的疗效确切,安全性高。超声直视下的A1滑车形态及其位置使该治疗趋向精准化,有利于该技术的普及和推广。

Objective:To evaluate the clinical efficacy of ultrasound-guided needle-knife therapy for trigger finger(TF).The shape and position of A1 pulley were measured and summarized under ultrasound to make the operation more accurate.Methods:A retrospective study was made on 60 patients(69 fingers)with TF treated by Needle-knife under ultrasound guidance from February 2016 to February 2018 in the outpatient department of the Third Affiliated Hospital of Beijing University of Chinese Medicine.The thickness of A1 pulley,Quinnell grade and VAS score were collected and analyzed before operation,2 weeks after and 1 month after operation.Meanwhile,the thickness and width of A1 pulley,its distance with nerves and vessles were measured and marked before operation.Results:Before and after operation,A1 pulley,Quinnell grade and VAS score were analyzed by single factor repeated measurement variance(P<0.01),with significant difference(P<0.05).The average thickness of A1 pulley was 1.54 mm,the average width of A1 pulley was 6.70 mm,the average distance between the proximal side of A1 pulley and the palmar transverse lines was 3.20 mm,and the average distance between the middle line of A1 pulley and the finger arteries on both sides was 8.00 mm.Conclusion:Needle-knife guided by musculoskeletal ultrasound is effective and safe in the treatment of stenosing tenosynovitis of flexor tendon.The morphology and location of A1 trolley summarized under the direct vision of ultrasound make the treatment more accurate,which is conducive to popularization and promotion.