ʻO ka styloid stenosis tenosynovitis kahi mumū aseptic i hoʻokumu ʻia e ka ʻeha a me ka pehu ʻana o nā tendon abductor pollicis longus a me nā extensor pollicis brevis ma ka dorsal carpal sheath ma ke kaʻina radial styloid. Hoʻonui ʻia nā hōʻailona me ka hoʻolōʻihi ʻana o ka manamana nui a me ka calimor deviation. Ua hōʻike mua ʻia ka maʻi e ke kauka lapaʻau Switzerland ʻo de Quervain i ka makahiki 1895, no laila ua ʻike ʻia ka radial styloid stenosis tenosynovitis ʻo ka maʻi de Quervain.
ʻOi aku ka maʻamau o ka maʻi i ka poʻe e hana pinepine ana i nā hana lima lima a me nā manamana lima palmar, a ua kapa ʻia hoʻi ʻo "lima makuahine" a me "manamana pāʻani". Me ka hoʻomohala ʻana o ka Pūnaewele, ke piʻi nei ka nui o ka poʻe i hoʻopilikia ʻia e ka maʻi a ʻōpio. No laila pehea e ʻike ai a mālama i kēia maʻi? E hāʻawi kēia iā ʻoe i kahi hoʻolauna pōkole mai ʻekolu mau ʻano: ke ʻano anatomical, ka ʻike lapaʻau a me nā ʻano lapaʻau!
ʻAnatomy
ʻO ke kaʻina hana styloid o ka radius he sulcus haiki a pāpaʻu i uhi ʻia e kahi ligament carpal dorsal e hana ana i kahi ʻūpā fibrous o ka iwi. ʻO ke abductor pollicis longus tendon a me ka extensor pollicis brevis tendon e hele ma waena o kēia ʻūpā a pelu i kahi kihi a hoʻopau ma ke kumu o ka iwi metacarpal mua a me ke kumu o ka proximal phalanx o ka manamana nui, kēlā me kēia (Kiʻi 1). Ke paheʻe ke tendon, aia kahi ikaika friction nui, ʻoiai ke kuhi hewa ʻana o ka wrist ulnar a i ʻole ka neʻe ʻana o ka manamana nui, piʻi ka kihi pelu, e hoʻonui ana i ka friction ma waena o ke tendon a me ka paia o ka ʻūpā. Ma hope o ka hoʻoulu mau ʻana no ka manawa lōʻihi, hōʻike ka synovium i nā loli mumū e like me ka edema a me ka hyperplasia, e hoʻoulu ai i ka mānoanoa, ka hoʻopili ʻana a i ʻole ka nawaliwali o ke tendon a me ka paia o ka ʻūpā, e hopena ana i nā hōʻike lapaʻau o ka stenosis tenosynovitis.
Kiʻi 1 Kiʻikuhi anatomical o ke kaʻina hana styloid o ka radius
II. Ka hōʻailona lapaʻau
1. ʻOi aku ka maʻamau o ka mōʻaukala lapaʻau i nā poʻe waena, nā mea hoʻohana lima, a ʻoi aku ka maʻamau i nā wahine; Lohi ka hoʻomaka ʻana, akā hiki ke ʻike koke ʻia nā hōʻailona.
2. Nā Hōʻailona: ʻeha kūloko ma ke kaʻina styloid o ka radius, hiki ke pālahalaha i ka lima a me ka lima mua, nāwaliwali o ka manamana nui, ka palena o ka hoʻolōʻihi ʻana o ka manamana nui, ka hoʻonui ʻia o nā hōʻailona i ka wā e hoʻolōʻihi ʻia ai ka manamana nui a me ka ʻaoʻao ulnar o ka pulima; Hiki ke ʻike ʻia nā nodules palpable ma ke kaʻina styloid o ka radius, e like me ka ʻoi ʻana o ka iwi, me ka palupalu nui.
3.ʻO ka hoʻāʻo ʻana a Finkelstein (ʻo ia hoʻi, ka hoʻāʻo ʻokoʻa o ka lima ulnar) he maikaʻi (e like me ka mea i hōʻike ʻia ma ke Kiʻi 2), ua kulou ʻia ka manamana nui a paʻa i loko o ka pālima, ua ʻokoʻa ka pulima ulnar, a ua hoʻonui ʻia ka ʻeha ma ke kaʻina hana radius styloid.
4. Hoʻokolokolo kōkua: Hiki ke hana ʻia ka hoʻokolokolo X-ray a i ʻole ke kala ultrasound inā pono e hōʻoia inā he ʻano ʻē o ka iwi a i ʻole synovitis. Nā Kuhikuhi no ka Lapaʻau Multidisciplinary o Styloid Stenosis Tenosynovitis o ka Radius E hoʻomaopopo he pono nā hoʻokolokolo kino ʻē aʻe e hoʻokaʻawale ma waena o ka osteoarthritis, nā maʻi o ka lālā superficial o ke aʻalolo radial, a me ka forearm cruciate syndrome i ka manawa o ka hōʻoia ʻana.
III. Lapaʻau
Lapaʻau mālama Lapaʻau hoʻopaʻa kūloko: I ke kahua mua, hiki i nā mea maʻi ke hoʻohana i kahi mea hoʻopaʻa paʻa waho e hoʻopaʻa i ka lālā i hoʻopilikia ʻia e hōʻemi i nā hana kūloko a hoʻomaha i ka friction o ke tendon i loko o ka ʻūpā tendon e hoʻokō ai i ka pahuhopu o ka mālama ʻana. Eia nō naʻe, ʻaʻole hiki i ka hoʻopaʻa ʻana ke hōʻoia i ka paʻa ʻana o ka lālā i hoʻopilikia ʻia, a ʻo ka hoʻopaʻa ʻana no ka manawa lōʻihi e hopena i ka paʻakikī o ka neʻe ʻana no ka manawa lōʻihi. ʻOiai ua hoʻohana ʻia nā lāʻau ʻē aʻe i kōkua ʻia e ka hoʻopaʻa ʻana i ka hana lapaʻau, ke hoʻopaʻapaʻa mau nei ka pono o ka lāʻau.
ʻO ka lāʻau lapaʻau kūloko: Ma ke ʻano he lāʻau lapaʻau conservative makemake ʻia no ka mālama ʻana i ka lāʻau lapaʻau, pili ka lāʻau lapaʻau kūloko i ka injection intrathecal ma kahi ʻeha kūloko e hoʻokō ai i ke kumu o ka anti-inflammatory kūloko. Hiki i ka lāʻau lapaʻau Occlusive ke hoʻokomo i nā lāʻau lapaʻau i loko o ka ʻeha, ka ʻeke sheath joint, ke kumu nerve a me nā ʻāpana ʻē aʻe, hiki ke hōʻemi i ka pehu a hōʻoluʻolu i ka ʻeha a hōʻoluʻolu i nā spasms i kahi manawa pōkole, a pāʻani i ke kuleana nui loa i ka mālama ʻana i nā lesions kūloko. ʻO ka lāʻau lapaʻau ka triamcinolone acetonide a me ka lidocaine hydrochloride. Hiki ke hoʻohana ʻia nā inikini sodium hyaluronate. Eia nō naʻe, hiki i nā hormones ke loaʻa nā pilikia e like me ka ʻeha ma hope o ka inikini, ka pigmentation ʻili kūloko, ka atrophy o ka ʻiʻo subcutaneous kūloko, ka hōʻeha radial nerve symptomatic, a me ke koko glucose kiʻekiʻe. ʻO nā contraindications nui he allergy hormone, nā maʻi hāpai a me nā mea hānai. ʻOi aku ka palekana o ka sodium hyaluronate a hiki ke pale i ka scarring o nā adhesions a puni ka tendon a hoʻolaha i ka ho'ōla ʻana o ka tendon. He maopopo ka hopena lapaʻau o ka lāʻau lapaʻau occlusive, akā aia nā hōʻike lapaʻau o ka necrosis manamana lima i hoʻokumu ʻia e ka injection kūloko kūpono ʻole (Kiʻi 3).
Kiʻi 3 ʻO ka occlusion hapa e alakaʻi ai i ka necrosis o nā manamana lima o nā manamana lima kuhikuhi: A. He ʻāpana ka ʻili o ka lima, a ʻo B, C. ʻO ka ʻāpana waena o ka manamana lima kuhikuhi he mamao loa ia, a he necrosis nā manamana lima.
Nā Mālama no ka lāʻau lapaʻau occlusive i ka mālama ʻana i ka radius styloid stenosis tenosynovitis: 1) Pololei ke kūlana, a pono e huki ʻia ka syringe ma mua o ke komo ʻana i ka lāʻau lapaʻau e hōʻoia i ka komo ʻole ʻana o ka nila injection i loko o ke kīʻaha koko; 2) Hoʻopaʻa kūpono ʻana o ka lālā i hoʻopilikia ʻia e pale aku i ka hoʻoikaika mua ʻana; 3) Ma hope o ka hoʻokomo ʻana i ka hormone occlusion, aia pinepine nā ʻano ʻeha like ʻole, ka pehu ʻana, a me ka hoʻonui ʻana o ka ʻeha, e nalowale pinepine ana i loko o 2 ~ 3 mau lā, inā ʻike ʻia ka ʻeha o ka manamana lima a me ka pallor, pono e hāʻawi koke ʻia ka lāʻau antispasmodic a me anticoagulant, a pono e hana ʻia ka angiography e hana i kahi hōʻailona maopopo inā hiki, a pono e hana koke ʻia ka ʻimi ʻana i nā vascular inā pono, i ʻole e hoʻopaneʻe i ke kūlana; 4) ʻAʻole pono e mālama ʻia nā contraindications hormonal e like me ke koko kiʻekiʻe, ka maʻi diabetes, ka maʻi puʻuwai, a me nā mea ʻē aʻe me ka occlusion kūloko.
ʻO Shockwave: he lāʻau lapaʻau mālama, ʻaʻole invasive nona ka pono o ka hoʻoulu ʻana i ka ikehu ma waho o ke kino a me ka hoʻopuka ʻana i nā hopena ma 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 hoʻolaha ʻana i ka metabolism, ka hoʻoikaika ʻana i ke kahe koko a me ka lymphatic, ka hoʻomaikaʻi ʻana i ka meaʻai o nā ʻiʻo, ka wehe ʻana i nā capillaries i ālai ʻia, a me ka wehe ʻana i nā hoʻopili ʻana o nā ʻiʻo palupalu. Eia nō naʻe, ua hoʻomaka ia ma hope o ka mālama ʻana i ka styloid stenosis tenosynovitis o ka radius, a he kakaikahi kāna mau hōʻike noiʻi, a pono mau nā haʻawina i hoʻomalu ʻia me ka randomized nui e hāʻawi i nā hōʻike lapaʻau hou aʻe 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 ʻano hoʻokuʻu pani ma waena o ka mālama ʻokiʻoki a me ka mālama ʻoki ʻole, ma o ka dredging a me ka ʻili ʻana o nā lesions kūloko, ua hoʻokuʻu ʻia nā adhesions, a ua hoʻomaha ʻia ka pahele ʻana o ka pūʻolo nerve vascular, a ua hoʻomaikaʻi ʻia ke kahe koko o nā ʻiʻo a puni ma o ka hoʻoulu ʻana o ka acupuncture, e hōʻemi ana i ka exudation inflammatory, a me ka hoʻokō ʻana i ke kumu o ka anti-inflammatory a me analgesic.
Lāʻau lapaʻau kuʻuna Kina: ʻO ka radial styloid stenosis tenosynovitis no ka māhele o "paralysis syndrome" i ka lāʻau lapaʻau o ka ʻāina hānau, a ua hoʻokumu ʻia ka maʻi ma ka hemahema a me ke kūlana. Ma muli o ka hana lōʻihi o ka hui pulima, ke kaumaha nui, e hopena ana i ka qi kūloko a me ke koko hemahema, ua kapa ʻia kēia ʻo ka hemahema mua; Ma muli o ka qi kūloko a me ke koko hemahema, ua nalowale nā ʻiʻo a me nā aʻa 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 hoʻonui ai i ka paʻa ʻana o ka qi a me ke koko, ʻike ʻia ua kaupalena ʻia ka pehu kūloko a me ka ʻeha a me ka hana, a ʻoi aku ka koʻikoʻi o ka hōʻiliʻili ʻana o qi a me ke koko a ʻoi aku ka koʻikoʻi o ka spasm kūloko, no laila ua ʻike ʻia ua hoʻonui ʻia ka ʻeha o ka hui pulima neʻe a me ka hui metacarpophalangeal mua i loko o ka hale lapaʻau, he kūlana maʻamau. Ua ʻike ʻia ma ke ʻano lapaʻau he hopena lapaʻau kekahi mau hopena lapaʻau ka moxibustion therapy, massage therapy, ka mālama waho o ka lāʻau lapaʻau kuʻuna Kina a me ka mālama acupuncture.
Lapaʻau ʻoki kino: ʻO ka ʻoki ʻoki ʻana i ka ligament carpal dorsal o ka radius a me ka excision palena ʻia kekahi o nā lāʻau lapaʻau no ka stenosis tenosynovitis i ke kaʻina styloid o ka radius. He kūpono ia no nā poʻe maʻi me ka tenosynovitis hou o ka radius styloid stenosis, kahi i kūleʻa ʻole ma hope o nā occlusions kūloko he nui a me nā lāʻau lapaʻau conservative ʻē aʻe, a he koʻikoʻi nā hōʻailona. ʻOi loa i nā poʻe maʻi me ka stenotic advanced tenosynovitis, hōʻoluʻolu ia i ka ʻeha koʻikoʻi a paʻakikī hoʻi.
ʻO ke ʻoki kino pololei: ʻO ke ʻano ʻoki kino maʻamau, ʻo ia ke ʻoki pololei ʻana ma kahi palupalu, e hōʻike i ka septum mua o nā ʻiʻo dorsal, e ʻoki i ka ʻūpā tendon mānoanoa, a hoʻokuʻu i ka ʻūpā tendon i hiki i ke tendon ke paheʻe manuahi i loko o ka ʻūpā tendon. He wikiwiki ka hoʻokō ʻana i ke ʻoki kino pololei, akā he nui nā pilikia ʻoki kino e like me ka maʻi, a ma muli o ka wehe pololei ʻana o ke kāʻei kākoʻo dorsal i ka wā o ke ʻoki kino, hiki ke hana ʻia ka dislocation tendon a me ka hōʻino ʻana i ke aʻalolo radial a me ke aʻa.
ʻO ka septolysis mua: ʻAʻole ʻoki kēia ʻano hana i ka ʻūpā tendon mānoanoa, akā wehe i ka cyst ganglion i loaʻa i ka septum extensor mua a ʻoki paha i ka septum ma waena o ka abductor pollicis longus a me ka extensor pollicis brevis e hoʻokuʻu i ka septum extensor dorsal mua. Ua like kēia ʻano hana me ke ʻoki wehe pololei, me ka ʻokoʻa nui ma hope o ka ʻoki ʻana i ke kāʻei kākoʻo extensor, hoʻokuʻu ʻia ka ʻūpā tendon a wehe ʻia ka ʻūpā tendon ma kahi o ka ʻoki ʻana i ka ʻūpā tendon mānoanoa. ʻOiai paha e loaʻa ka subluxation tendon i kēia ʻano hana, pale ia i ka septum extensor dorsal mua a ʻoi aku ka maikaʻi o ka lōʻihi no ke kūpaʻa tendon ma mua o ka ʻoki pololei ʻana o ka ʻūpā tendon. ʻO ka hemahema o kēia ʻano hana ma muli o ka ʻoiaʻiʻo ʻaʻole i wehe ʻia ka ʻūpā tendon mānoanoa, a hiki i ka ʻūpā tendon mānoanoa ke mumū, edema, a me ka friction me ka tendon e alakaʻi i ka hoʻi hou ʻana o ka maʻi.
Hoʻonui ʻia ke alapine osteofibrous Arthroscopic: loaʻa i ka mālama ʻana i ka arthroscopic nā pono o ka emi ʻana o ka trauma, ka pōkole o ke kaʻina hana, ka palekana kiʻekiʻe, ka emi ʻana o nā pilikia a me ka wikiwiki o ka hoʻōla ʻana, a ʻo ka pono nui loa, ʻaʻole i ʻoki ʻia ke kāʻei kākoʻo extensor, a ʻaʻohe dislocation tendon. Eia nō naʻe, aia nō ka hoʻopaʻapaʻa, a manaʻo kekahi poʻe akamai he pipiʻi a he lōʻihi ka hana ʻoki arthroscopic, a ʻaʻole maopopo loa kona mau pono ma mua o ke ʻoki wehe pololei. No laila, ʻaʻole i koho pinepine ʻia ka mālama ʻana i ka arthroscopic e ka hapa nui o nā kauka a me nā maʻi.
Ka manawa hoʻouna: ʻOkakopa-29-2024
