基于解剖结构的桡骨茎突狭窄性腱鞘炎研究进展

Research progress of stenosing tenosynovitis of radial styloid process based on anatomical structure

桡骨茎突狭窄性腱鞘炎又称de Quervain病,是第1伸肌室内的拇长展肌及拇短伸肌在滑动时受阻力产生疼痛,桡骨茎突狭窄性腱鞘炎的发病与其解剖结构是密切相关的,通过症状及体征与辅助检查能较好的确诊该病。轻微的桡骨茎突狭窄性腱鞘炎通过休息、支具限制活动及口服药物等就能得到改善,中医疗法及理疗也对该病有一定帮助。针刀疗法作为中医微创手术,是一种介于保守治疗与开放性手术之间的梯级治疗,通过松解第1伸肌室来解除卡压。类固醇注射是该病临床较常见的治疗方式,其疗效与注射的精准程度有关同时受到患者基于解剖结构变异的病情严重程度的影响。在超声下识别第1伸肌室内的间隔能帮助患者更好的选择保守疗法或手术治疗。手术疗法能更彻底从解剖结构上改善桡骨茎突狭窄性腱鞘炎的病情,临床应注意术式的选择以减少手术并发症的产生。本文从解剖结构方面论述该病的发病、诊断及治疗,主要分析各疗法的治疗靶点及临床选择运用情况,旨在为桡骨茎突狭窄性腱鞘炎的诊断和治疗提供参考。

Stenosing tenosynovitis of styloid process of radius(de Quervain’s disease)which abductor pollicis longus and extensor pollicis brevis in the first extensor chamber are affected by resistance when sliding,the incidence is affected by anatomical variations.Symptoms,signs and auxiliary examinations can diagnose the disease.Slight dQS can be improved by rest,brace,restriction activities,and oral medications.Chinese medicine and physiotherapy also reduce the disease.Needle knife therapy is a Traditional Chinese medicine minimally invasive surgery,which is also a step-by-step treatment between conservative treatment and open surgery to loosening the compression of the first extensor chamber.Steroid injection is a more common treatment in this disease,and its efficacy is related to the accuracy of the injection and is affected by the severity of the patient’s anatomical variation.Identifying the spacing within the first extensor chamber under ultrasound can help patients better choose conservative or surgical treatment.Surgical treatment can more completely change the condition of dQD from anatomical structure,and clinical should pay attention to the choice of surgical procedure to improve the efficacy and reduce the occurrence of surgical complications.This article discusses the pathogenesis,diagnosis and treatment of the disease from the perspective of anatomical structure.It mainly analyzes the therapeutic targets and the clinical application,which aims to provide reference for the diagnosis and treatment of de Quervain disease.