长圆针治疗拇长屈肌腱腱鞘炎临床观察

Clinical Observation on Long-round Needle Therapy in Treatment of Thumb-flexor Tenosynovitis

目的：观察长圆针疗法治疗拇长屈肌腱腱鞘炎的疗效。方法：选取2014年10月至2016年10月大连理工大学医院门诊部就诊的120例拇长屈肌腱腱鞘炎患者，按随机数字表法将患者分为长圆针组和封闭组，每组60例。长圆针组患者取坐位或仰卧位，通过触诊标记掌指1、鱼际次、臂中次、肱骨内髁、肱中次、泽下次、曲泽次、肩内陵次、中府次等结筋病灶点。每次选取2-4个，局麻后持长圆针行关刺与恢刺法解结。封闭组以曲安奈德20mg、2％利多卡因1mL、生理盐水1．5mL混匀，沿腱鞘向指端方向注射入痛点。两组均每周治疗1次，连续治疗4周，记录治疗前后及随访的疼痛视觉模拟评分（VAS）、改良Michigan手功能评价量表（MHQ）分值，评价疗效。结果：疗效评价方面，长圆针组优于封闭组（P〈0．05）；两组治疗后VAS、MHQ分值较治疗前明显下降（P〈0．05），且长圆针组优于封闭组（P〈0．05）；与治疗后相比，随访时长圆针组VAS、MHQ分值无显著变化（P〉0．05），封闭组VAS、MHQ分值变化明显（P〈0．01）。结论：长圆针治疗拇长屈肌腱腱鞘炎可以及时缓解疼痛、改善功能，疗效显著，且具有一定的长效性。

Objective：To observe the curative effects of long-round acupuncture in treating thumb-flexor tenosynovitis. Methods：Total 120 patients were selected from the outpatient department of Affiliated Hospital of Dalian University of Technology from October 2014 to October 2016. According to random number table,the patients were divided into the long-round needle group and block group with 60 patients in each group. Long-round needle group of patients were sitting or supine position,through palpation marking the common tendon focus points,which are Zhangzhi 1 ,Yujici, Bizhongci, Gonggu neike,Gongzhongci,Zexiaci,Quzeci, Jianneilingci and Zhongfuci,each selected 2-4 points,after the local anesthesia with a long-round needle puncture. The block group was treated with triamcinolone acetonide 20 mg,2% lidocaine 1 mL,and physiological saline 1.5 mL,and then injected into the pain point along the tendon sheath. The two groups were treated once a week for continuous 4 weeks. The visual analog scale（VAS） and michigan hand outcomes questionnaire（MHQ） scores were recorded before and after treatment,and the curative effect was evaluated.Results：The efficacy of the long-round needle group is better than that of the block group. After treatment,the scores of VAS and MHQ in the two groups were significantly reduced（P〈0.05）,and the scores of VAS and MHQ scores of the long-round needle group were significantly better than those of the block group （P〈0.05）. During following-up, the VAS and MHQ scores of the long-round needle group were not significantly changed（P〉O.05）,but those of the block group were changed（P〈O.O1）. Conclusion：Long-round needle acupuncture treatment of thumb-flex-or tenosynovitis could relieve pain,improve functions and have a long-term curative effect.