ʻO Styloid stenosis tenosynovitis kahi ʻeha aseptic i kumu ʻia e ka ʻeha a me ka pehu ʻana o ka abductor pollicis longus a me ka extensor pollicis brevis tendons ma ka dorsal carpal sheath ma ke kaʻina radial styloid. Hoʻonui ʻia nā hōʻailona me ka hoʻonui ʻana o ka manamana lima a me ka haʻalele ʻana o ka calimor. Ua hōʻike mua ʻia kēia maʻi e ke kauā o Switzerland de Quervain i ka makahiki 1895, no laila ua ʻike ʻia ka radial styloid stenosis tenosynovitis ʻo ka maʻi de Quervain.
ʻOi aku ka maʻi maʻamau i ka poʻe e hana pinepine ana i nā hana lima lima a me nā manamana lima, a ʻike ʻia hoʻi ʻo "ka lima makuahine" a me ka "lima lima pāʻani". Me ka hoʻomohala ʻana o ka Pūnaewele, ke piʻi aʻe nei ka nui o nā poʻe i loaʻa i ka maʻi. No laila pehea e ʻike ai a mālama i kēia maʻi? E hāʻawi ana kēia iā ʻoe i kahi hoʻolauna pōkole mai ʻekolu mau ʻano: anatomical structure, clinical diagnostic and treatment method!
I.Anatomy
ʻO ke kaʻina hana styloid o ka radius he hāiki a pāpaʻu ka sulcus i uhi ʻia e ka dorsal carpal ligament i hana ʻia i kahi puʻu fibrous o ka iwi. ʻO ka abductor pollicis longus tendon a me ka extensor pollicis brevis tendon e hele i loko o kēia pūʻulu a pelu ma kahi kihi a hoʻopau ma ke kumu o ka iwi metacarpal mua a me ke kumu o ka phalanx proximal o ka manamana lima, kēlā me kēia (Figure 1). I ka paheʻe ʻana o ka ʻāʻī, nui ka ikaika friction, ʻoi aku hoʻi i ka wā o ka neʻe ʻana o ka ulnar wrist a i ʻole ka neʻe ʻana o ka manamana lima, piʻi ka huina o ka pelu, e hoʻonui ana i ka friction ma waena o ka tendon a me ka paia puʻu. Ma hope o ka hoʻoulu ʻana i ka wā lōʻihi, hōʻike ka synovium i nā loli inflammatory e like me ka edema a me ka hyperplasia, e hoʻoulu ai i ka mānoanoa, adhesion a i ʻole ke ʻoki ʻana o ka tendon a me ka pā sheath, e hopena i nā hōʻike hōʻike o stenosis tenosynovitis.
Fig.1 Anatomical diagram of the styloid process of the radius
II.Ka maʻi maʻi
1. ʻO ka mōʻaukala olakino ka mea maʻamau i waena o nā makahiki waena, nā mea hana lima, a ʻoi aku ka maʻamau o nā wahine; He lohi ka hoʻomaka ʻana, akā hiki koke mai nā hōʻailona.
2.Signs: localized eha i loko o ka styloid kaʻina o ka radius, e hiki ke hoʻomālamalama i ka lima a me ka forearm, nawaliwali thumb, kaupalena thumb extension, aggravation o symptoms ke hoonui thumb a me ka wrist ulnar deviation; Hiki ke ʻike ʻia nā nodules palpable ma ke kaʻina styloid o ka radius, e like me ke ʻano o ka iwi, me ke ʻano palupalu.
3.He maikaʻi ka hoʻāʻo ʻana a Finkelstein (ʻo ia hoʻi, ʻo ka hoʻoheheʻe ʻana i ka ulnar fist) (e like me ka mea i hōʻike ʻia ma ke Kiʻi 2), hoʻopaʻa ʻia ka manamana lima a paʻa i ka pālima, ʻae ʻia ka ulnar wrist, a ʻoi aku ka ʻeha ma ke kaʻina radius styloid.
4. Auxiliary noʻonoʻo: X-ray a kala kala ultrasound hiki ke hana inā pono e hōʻoia inā he iwi abnormality a synovitis paha. ʻO nā alakaʻi no ka mālama ʻana i nā ʻano like ʻole o Styloid Stenosis Tenosynovitis o ka Radius E hoʻomaopopo he pono nā hoʻokolohua kino ʻē aʻe e hoʻokaʻawale i waena o ka osteoarthritis, nā maʻi o ka lālā papa o ke aʻalolo radial, a me ka forearm cruciate syndrome i ka manawa o ka maʻi.
III.Laapaau
Conservative TherapyLocal immobilization therapy: I ka wā mua, hiki i nā poʻe maʻi ke hoʻohana i kahi pale hoʻoponopono o waho e hoʻopaʻa i ka lālā i hoʻopilikia ʻia e hōʻemi i nā hana kūloko a hoʻomaha i ka friction o ka tendon i ka sheath tendon e hoʻokō i ka pahuhopu o ka mālama ʻana. Eia naʻe, ʻaʻole hiki i ka immobilization ke hōʻoia i ka paʻa ʻana o ka lālā i hoʻopili ʻia, a ʻo ka hoʻopaʻa ʻana i ka lōʻihi e hopena i ka ʻoʻoleʻa holo lōʻihi. ʻOiai ua hoʻohana ʻia nā lāʻau lapaʻau immobilization-kōkua ʻia i ka hoʻomaʻamaʻa lapaʻau, ke kūpaʻa nei ka maikaʻi o ka mālama ʻana.
ʻO ka lāʻau occlusion kūloko: E like me ke ʻano conservative therapy i makemake ʻia no ka mālama ʻana i ka lāʻau lapaʻau, pili ka lāʻau occlusion kūloko i ka injection intrathecal ma ke kahua ʻeha kūloko e hoʻokō ai i ke kumu o ka anti-inflammatory kūloko. Hiki i ka Occlusive therapy ke hoʻokuʻu i nā lāʻau i loko o ka ʻāpana ʻeha, ka ʻeke ʻeke hui, ke kumu aʻalolo a me nā ʻāpana ʻē aʻe, hiki ke hōʻemi i ka pehu a hoʻomaha i ka ʻeha a hoʻomaha i ka spasms i ka manawa pōkole, a e pāʻani i ka hana nui i ka mālama ʻana i nā ʻeha kūloko. ʻO ka lāʻau lapaʻau ka nui o ka triamcinolone acetonide a me ka lidocaine hydrochloride. Hiki ke hoʻohana pū ʻia nā injections sodium hyaluronate. Eia nō naʻe, loaʻa paha i nā hormones nā pilikia e like me ka ʻeha post-injection, ka ʻili o ka ʻili kūloko, ke atrophy o ka ʻiʻo subcutaneous kūloko, ka hōʻeha aʻalolo radial hōʻailona, a me ke kiʻekiʻe o ka glucose koko. ʻO nā contraindications nui he allergy hormone, nā maʻi hāpai a me ka lactating. ʻOi aku ka palekana o ka sodium hyaluronate a hiki iā ia ke pale i ka ʻili ʻana o nā adhesions a puni ka tendon a hoʻoikaika i ka hoʻōla ʻana o ka tendon. ʻIke ʻia ka hopena lapaʻau o ka occlusive therapy, akā aia nā hōʻike lapaʻau o ka necrosis manamana lima i hoʻokumu ʻia e ka inikia kūloko kūpono ʻole (Figure 3).
Fig.3 ʻO ka hoʻopiʻi hapa ke alakaʻi i ka necrosis o nā manamana lima o nā manamana lima: A. ʻO ka ʻili o ka lima he ʻōpala, a me B, C. ʻO ka māhele waena o ka manamana lima he mamao loa, a ʻo nā manamana lima he necrosis.
ʻO ka mālama ʻana i ka lāʻau lapaʻau occlusive i ka mālama ʻana i ka radius styloid stenosis tenosynovitis: 1) Pono ke kūlana, a pono e hoʻihoʻi ʻia ka syringe ma mua o ka hoʻokomo ʻana i ka lāʻau no ka hōʻoia ʻana ʻaʻole e komo ka nila i loko o ka moku koko; 2) ʻO ka immobilization kūpono o ka lālā i hoʻopilikiaʻia e pale i ka hana mua; 3) Ma hope o ka hoʻoneʻe ʻana i ka hormone, loaʻa pinepine nā degere o ka ʻeha, pehu, a me ka hōʻeha ʻana o ka ʻeha, maʻamau e nalowale i nā lā 2 ~ 3, inā ʻike ʻia ka ʻeha a me ka pallor o ka manamana lima, pono e hāʻawi koke ʻia ka antispasmodic a me ka anticoagulant therapy, a pono e hana ʻia ka angiography e hana i kahi hōʻailona maopopo inā hiki, a pono e hoʻokō ʻia ka ʻimi vascular i ka wā hiki ke hiki; 4) ʻAʻole pono e mālama ʻia nā contraindications hormonal e like me ke kiʻekiʻe kiʻekiʻe, ka maʻi diabetes, ka maʻi puʻuwai, a me nā mea ʻē aʻe me ka occlusion kūloko.
Shockwave: he lapaʻau conservative, non-invasive i loaʻa ka pono o ka hoʻoulu ʻana i ka ikehu ma waho o ke kino a hana i nā hopena i nā wahi i kuhikuhi ʻia i loko o ke kino me ka ʻole o ka hōʻino ʻana i nā ʻiʻo a puni. Loaʻa iā ia ka hopena o ka hoʻoikaika ʻana i ka metabolism, hoʻoikaika i ke koko a me ke kahe o ka lymphatic, hoʻomaikaʻi i ka meaʻai o ka ʻiʻo, ka huki ʻana i nā capillaries i hoʻopaʻa ʻia, a me ka wehe ʻana i nā adhesions a me nā ʻiʻo palupalu. Eia nō naʻe, ua hoʻomaka i ka hopena o ka mālama ʻana i ka styloid stenosis tenosynovitis o ka radius, a he kakaikahi kāna mau noiʻi noiʻi, a ʻo nā haʻawina i hoʻopaʻa ʻia randomized e pono mau e hāʻawi i nā hōʻike lapaʻau e pili ana i nā hōʻike e hoʻolaha i kona hoʻohana ʻana i ka mālama ʻana i ka maʻi styloid stenosis tenosynovitis o ka radius.
ʻO ka mālama ʻana i ka Acupuncture: ʻo ka mālama ʻana i ka acupuncture liʻiliʻi he ala hoʻokuʻu i pani ʻia ma waena o ka mālama ʻana a me ka mālama ʻole ʻana, ma o ka huki ʻana a me ka ʻili ʻana o nā ʻeha kūloko, ua hoʻokuʻu ʻia nā adhesions, a ʻoi aku ka maikaʻi o ka hoʻopaʻa ʻana o ka pūpū nerve vascular, a ua hoʻomaikaʻi ʻia ke kahe koko o nā ʻiʻo a puni ma o ka hoʻoulu ʻana o ka acupuncture, anti-inflammatory acupuncture. a me ka analgesic.
ʻO ka lāʻau lapaʻau Kina maʻamau: ʻO Radial styloid stenosis tenosynovitis no ka māhele o ka "paralysis syndrome" i ka lāʻau lapaʻau o ka ʻāina makuahine, a ua kau ʻia ka maʻi ma luna o ka hemahema a me ka maʻamau. Ma muli o ka hana lōʻihi o ka hui lima, ke kaumaha nui, ka hopena i ka qi kūloko a me ke koko hemahema, ua kapa ʻia kēia ka hemahema kumu; Ma muli o ka nele o ka qi a me ke koko, ua nalowale nā ʻiʻo a me nā ʻiʻo i ka meaʻai a me ka pahee, a ma muli o ka manaʻo o ka makani, ke anu a me ka pulu, ka mea e hōʻeha ai i ka paʻa ʻana o ka qi a me ka hana koko, ʻike ʻia ua kaupalena ʻia ka pehu a me ka ʻeha a me ka hana, a me ka hōʻiliʻili ʻana o ka qi a me ke koko, ʻoi aku ka koʻikoʻi a ʻoi aku ka nui o ka ʻeha a me ka ʻeha o ka ʻeha. ʻo ka hui metacarpophalangeal mua i hoʻonuiʻia i loko o ke keʻena kino,ʻo ia ke kūlana. Ua ʻike ʻia ʻo ka moxibustion therapy, massage therapy, ka mālama ʻana i waho o ka lāʻau lapaʻau kuʻuna Kina a me ka lāʻau acupuncture kekahi mau hopena lapaʻau.
ʻO ka lāʻau lapaʻau: ʻO ka ʻokiʻoki ʻana o ka ligament carpal dorsal o ka radius a me ka excision liʻiliʻi kekahi o nā lapaʻau no ka stenosis tenosynovitis ma ke kaʻina styloid o ka radius. He kūpono ia no nā poʻe maʻi me ka tenosynovitis recurrent of radius styloid stenosis, ka mea i hana ʻole ma hope o ka nui o nā occlusions kūloko a me nā lāʻau conservative ʻē aʻe, a ua koʻikoʻi nā hōʻailona. ʻOi loa i nā mea maʻi me ka stenotic advanced tenosynovitis, hoʻomaha ia i ka ʻeha nui a me ka refractory.
ʻO ka ʻoki wehe ʻana: ʻO ke ʻano hana maʻamau, ʻo ia ke ʻoki pololei ʻana i ka ʻāpana palupalu, e hōʻike i ka septum ʻiʻo hope mua, ʻoki i ka puʻupuʻu mānoanoa, a hoʻokuʻu i ka puʻu aʻa i hiki i ka tendon ke paheʻe wale i loko o ka pū. Hiki ke hoʻokō ʻia ke ʻoki hāmama pololei, akā lawe ia i kahi ʻano o nā pilikia o ka ʻoki ʻana e like me ka maʻi, a ma muli o ka wehe pololei ʻana i ke kāʻei kākoʻo dorsal i ka wā o ke kaʻa ʻana, hiki ke hōʻeha ʻia ka tendon a me ka pōʻino i ke aʻalolo radial a me ka vein.
ʻO ka 1st septolysis: ʻAʻole ʻoki kēia ʻano ʻoki i ka puʻu tendon mānoanoa, akā wehe i ka ganglion cyst i loaʻa i ka 1st extensor septum a ʻoki paha i ka septum ma waena o ka abductor pollicis longus a me extensor pollicis brevis e hoʻokuʻu i ka 1st dorsal extensor septum. Ua like kēia ʻano me ka ʻoki hāmama pololei, ʻo ka ʻokoʻa nui ma hope o ka ʻoki ʻana i ke kāʻei kākoʻo extensor, ua hoʻokuʻu ʻia ka ʻāʻī a wehe ʻia ka ʻāʻī ma kahi o ka ʻoki ʻana o ka pū ʻāʻī mānoanoa. ʻOiai hiki ke loaʻa ka subluxation tendon i kēia ʻano, pale ia i ka 1st dorsal extensor septum a ʻoi aku ka maikaʻi o ka wā lōʻihi no ka paʻa ʻana o ka tendon ma mua o ka wehe pololei ʻana o ka sheath tendon. ʻO ka pōʻino o kēia ʻano ma muli o ka wehe ʻole ʻia ʻana o ka ʻūhā mānoanoa, a ʻo ka ʻūhā mānoanoa paha e ʻeha, edema, a me ka friction me ka tendon e alakaʻi i ka hoʻi hou ʻana o ka maʻi.
Arthroscopic osteofibrous duct augmentation: arthroscopic lapaʻau i ka pono o ka liʻiliʻi trauma, pōkole lāʻau pōʻaiapuni, kiʻekiʻe palekana, ka liʻiliʻi complications a me ka wikiwiki ho'ōla hou, a me ka nui o ka pono 'ole ka extensor kākoʻo kāʻei 'aʻole i incised, aʻaʻohe tendon dislocation. Eia nō naʻe, aia nō ka hoʻopaʻapaʻa, a ke manaʻoʻiʻo nei kekahi poʻe naʻauao he pipiʻi a hoʻopau manawa ke ʻoki arthroscopic, a ʻaʻole maopopo loa nā mea maikaʻi ma mua o ke oki hāmama. No laila, ʻaʻole koho ʻia ka lāʻau arthroscopic e ka hapa nui o nā kauka a me nā maʻi.
Ka manawa hoʻouna: Oct-29-2024
