改良针刀术式治疗Ⅱ、Ⅲ度拇长屈肌腱狭窄性腱鞘炎临床研究

Clinical Study of Modified Acupotomy in Treating FTST of Degree Ⅱ and Ⅲ

目的:观察针刀治疗Ⅱ、Ⅲ度拇长屈肌腱狭窄性腱鞘炎患者的临床疗效。方法:按照标准纳入Ⅱ、Ⅲ度拇长屈肌腱狭窄性腱鞘炎患者共93例,使用随机数字表法分为试验组与对照组。有8名患者脱落,最终试验组43名,对照组42名。试验组采用针刀治疗,对照组采用封闭疗法。比较两组患者治疗前后、治疗后3个月的Quinnell分级评分、VAS评分、拇指掌指关节处弹响、绞锁、硬结情况、拇指指间关节主动屈曲活动度以及临床有效率。结果:试验组术后Quinnell评分优于对照组(P<0.05),表明针刀组术后Quinnell分级评分结果更佳。与术前比较,两组术后即刻及术后3个月VAS评分均有明显改善(P<0.05);两组术后即刻VAS评分比较,试验组优于对照组(P<0.05);术后3个月VAS评分比较,试验组下降程度优于对照组(P<0.05)。试验组拇指指间关节主动活动度优于对照组(P<0.05)。试验组弹响、绞锁、硬结改善优于对照组(P<0.05)。对照组术前、术后、术后3月硬结无统计学意义(P>0.05)。试验组临床总有效率90.70%(39/43),对照组为64.29%(27/42),试验组临床总有效率优于对照组(P<0.05)。结论:针刀治疗Ⅱ、Ⅲ度拇长屈肌腱狭窄性腱鞘炎操作简便,具有缓解疼痛、治疗弹响、绞锁、硬结效果显著、改善关节活动度、长期效果明显等优点,为临床针刀疗法的运用提供更有效的参考。

Objective:To observe the clinical efficacy of modified acupotmoy in the treatment of flexor tendon stenosing tenosynovitis(FTST)of degreeⅡandⅢ.Methods:93 patients met the inclusion criteria were randomly divided into the trail group(n=43)and the control group(n=42),8 patients did not complete the trial.The trial group was treated with modified acupotomy and the control group was treated with blocking therapy.The Quinnell grading score,VAS score,snapping thumb,locked facet dislocation,callous,active flexion activity of thumb and interphalangeal joint and clinical efficiency were observed and compared before the treatment,after the operation and three months after the operation in the two groups.Results:The postoperative Quinnell score of the trial group was better improved than that of the control group(P<0.05).VAS scores were significantly improved immediately after the operation and 3 months after the operation,compared to those before the operation in the two groups(P<0.05);of which the trial group improved more significantly(P<0.05).The range active flexion activity was better in the trail group than that in the control group(P<0.05).The improvements in snapping thumb,locked facet dislocation and callous were more significant in the trial group than those in the control group(P<0.05).There was no statistical difference in callous in the control group among before the operation,after the operation and 3 months after the operation(P>0.05).The total clinical effective rate was 90.70%in the trial group,which was significantly higher than 64.29%in the control group(P<0.05).Conclusion:Modified acupotomy is a simple and effective therapy for FTST of degreeⅡandⅢ.It has the advantages in relieving pain,treating snapping thumb,locked facet dislocation and callous,improving joint mobility with its long-term effect.It provides significant reference for clinical application of acupotomy.