Styloid stenosis tenosynovitis bụ mbufụt aseptic kpatara mgbu na ọzịza nke abductor pollicis longus na extensor pollicis brevis akwara na dorsal carpal sheath na usoro radial styloid. Mgbaàmà na-akawanye njọ site na mgbati mkpịsị aka ukwu na mgbanwe calimor. Ọ bụ dọkịta na-awa Switzerland de Quervain bụ onye mbụ kọrọ ọrịa a na 1895, ya mere a na-akpọkwa radial styloid stenosis tenosynovitis dị ka ọrịa de Quervain.
Ọrịa a na-adịkarị na ndị mmadụ na-eme ihe nrịba aka na mkpịsị aka ugboro ugboro, a makwaara ya dị ka “aka nne” na “mkpịsị aka egwuregwu”. Site na mmepe nke ịntanetị, ọnụ ọgụgụ ndị mmadụ na-arịa ọrịa na-arịwanye elu na-eto eto. Yabụ kedu ka esi achọpụta ma gwọọ ọrịa a? Ihe na-esonụ ga-enye gị okwu mmeghe dị nkenke site n'akụkụ atọ: nhazi nke anụ ahụ, nchọpụta ụlọ ọgwụ na ụzọ ọgwụgwọ!
I. Anatomi
Usoro styloid nke radius nwere sulcus dị warara, nke na-emighị emi nke ejiri eriri carpal azụ azụ kpuchie nke na-etolite n'ọbọ fibrous nke ọkpụkpụ. Ọkpụkpụ pollicis longus na-eme ihe na-eme ihe na-aga n'ihu na-agafe n'ọbọ a wee gbakọọ n'otu akụkụ wee kwụsị n'ala ọkpụkpụ nke mbụ metacarpal na isi nke phalanx dị nso nke isi mkpịsị aka, n'otu n'otu (Fig 1). Mgbe akwara akwara na-ada, a na-enwe nnukwu ike esemokwu, ọkachasị mgbe mgbagharị nkwojiaka ma ọ bụ mmegharị mkpịsị aka, akụkụ mpịaji na-abawanye, na-abawanye esemokwu n'etiti akwara na mgbidi n'ọbọ. Mgbe ogologo oge na-akpali akpali na-adịghị ala ala, synovium na-enye mgbanwe mkpali dị ka edema na hyperplasia, na-eme ka mkpụkọ, nrapado ma ọ bụ mbelata nke akwara na mgbidi n'ọbọ, na-ebute ngosipụta ụlọ ọgwụ nke stenosis tenosynovitis.
Fig.1 Anatomical eserese nke usoro styloid nke radius
II. Clinical nchoputa
1.Akụkọ ahụike na-adịkarị n'etiti ndị agadi, ndị na-arụ ọrụ ntuziaka, na ndị inyom na-emekarị; Mmalite na-eji nwayọ, mana mgbaàmà nwere ike ime na mberede.
2.Akara ngosi: mgbu mpaghara na usoro styloid nke radius, nke nwere ike ịgbanye aka na aka na aka, adịghị ike mkpịsị aka, njedebe mkpịsị aka ukwu, mmụba nke mgbaàmà mgbe mgbatị mkpịsị aka na nkwojiaka ulnar deviation; Nodules na-ahụ anya nwere ike ịdị na-emetụ n'ahụ na usoro styloid nke radius, nke yiri nnukwu ọkpụkpụ, na-enwe mmetụta dị nro.
3.Nnwale Finkelstein (ya bụ, fist ulnar deviation test) dị mma (dị ka egosiri na Figure 2), a na-emegharị mkpịsị aka ma jide n'aka n'ọbụ aka, nkwojiaka ulnar na-atụgharị, na mgbu na usoro radius styloid na-akawanye njọ.
4.Auxiliary Nyocha: Enwere ike ịme nyocha X-ray ma ọ bụ ụcha ultrasound ma ọ bụrụ na ọ dị mkpa iji kwado ma ọ bụrụ na ọ bụ ọkpụkpụ ọkpụkpụ ma ọ bụ synovitis. Ntuziaka maka ọgwụgwọ multidisciplinary Styloid Stenosis Tenosynovitis nke Radius Rịba ama na a chọrọ nyocha anụ ahụ ndị ọzọ iji mara ọdịiche dị n'etiti ọrịa ogbu na nkwonkwo, ọrịa nke ngalaba elu nke akwara radial, na ọrịa forearm cruciate n'oge nchoputa.
III.Ọgwụgwọ
Usoro ọgwụgwọ mgbanwe mpaghara: N'oge mmalite, ndị ọrịa nwere ike iji ihe nkwado nke mpụga na-eme ka akụkụ ahụ emetụtara belata iji belata ihe omume mpaghara ma wepụ esemokwu nke akwara na n'ọbọ akaị iji nweta ebumnuche ọgwụgwọ. Otú ọ dị, immobilization nwere ike ọ gaghị achọpụta na akụkụ ahụ emetụtara dị, na nkwụsịtụ ogologo oge nwere ike ịkpata nhịahụ ogologo oge. Ọ bụ ezie na a na-eji ọgwụgwọ ndị ọzọ na-enyere aka n'enweghị ike ime ihe n'ụzọ doro anya na omume ụlọ ọgwụ, ịdị irè ọgwụgwọ na-anọgide na-arụrịta ụka.
Usoro ọgwụgwọ nchikota mpaghara: Dị ka ọgwụgwọ nlekọta ahụike kachasị mma maka ọgwụgwọ ụlọ ọgwụ, ọgwụgwọ nkwụsịtụ mpaghara na-ezo aka na intrathecal injection na saịtị mgbu iji nweta nzube nke mgbochi mkpali mpaghara. Usoro ọgwụgwọ na-adịghị mma nwere ike ịgbanye ọgwụ n'ime ebe ahụ na-egbu mgbu, akpa mkpuchi nkwonkwo, ogwe akwara na akụkụ ndị ọzọ, nke nwere ike ibelata ọzịza ma wepụ ihe mgbu ma wepụ spasms n'ime oge dị mkpirikpi, ma rụọ ọrụ kachasị ukwuu na ọgwụgwọ nke ọnya mpaghara. Usoro ọgwụgwọ ahụ gụnyere triamcinolone acetonide na lidocaine hydrochloride. A pụkwara iji injections hyaluronate sodium. Otú ọ dị, hormones nwere ike inwe nsogbu dị ka ihe mgbu mgbe ịgbanye ọgwụ, pigmentation akpụkpọ anụ mpaghara, atrophy anụ ahụ subcutaneous mpaghara, mmerụ ahụ radial mgbaàmà, na mmụba ọbara glucose. Isi contraindications bụ hormone allergy, ime na lactating ọrịa. Sodium hyaluronate nwere ike ịdị nchebe karịa ma nwee ike igbochi ọnya adhesions n'akụkụ akaị ahụ ma kwalite ọgwụgwọ akwara. Mmetụta ahụike nke ọgwụgwọ occlusive doro anya, mana enwere akụkọ gbasara ụlọ ọgwụ nke necrosis mkpịsị aka kpatara site na ntụtụ mpaghara na-ezighi ezi (Nyocha 3).
Fig.3 Occlusion akụkụ na-eduga na necrosis nke mkpịsị aka mkpịsị aka nke mkpịsị aka mkpịsị aka: A. Akpụkpọ anụ nke aka dị nro, na B, C. Akụkụ etiti nke mkpịsị aka mkpịsị aka dị anya, na mkpịsị aka bụ necrosis.
Akpachara anya maka ọgwụgwọ occlusive na ọgwụgwọ nke radius styloid stenosis tenosynovitis: 1) Ọnọdụ ahụ ziri ezi, a ga-ewepụkwa sirinji ahụ tupu ịgbanye ọgwụ ahụ iji hụ na agịga injection adịghị abanye n'ime arịa ọbara; 2) Ntugharị kwesịrị ekwesị nke akụkụ ahụ emetụtara iji zere mgbatị ahụ akaghi aka; 3) Mgbe ogwu ogbugba nke hormone, a na-enwekarị ọkwa dị iche iche nke mgbu, ọzịza, na ọbụna njọ nke mgbu, n'ozuzu na-apụ n'anya na 2 ~ 3 ụbọchị, ma ọ bụrụ na mkpịsị aka mgbu na pallor pụtara, a ga-enye ọgwụ antispasmodic na anticoagulant ngwa ngwa, na angiography kwesịrị ịrụ iji mee ka nchọpụta doro anya ma ọ bụrụ na ọ ga-ekwe omume, na nyocha nke vaskụla kwesịrị ime ozugbo enwere ike ọ bụrụ na ọ dị mkpa ka ọ bụrụ na ọ dị mkpa, ya mere, ọ bụrụ na ọ dị mkpa, ọ bụrụ na ọ dị mkpa, ọ bụrụ na ọ dị mkpa. 4) contraindications nke homonụ dị ka ọbara mgbali elu, ọrịa shuga, ọrịa obi, wdg, ekwesịghị iji mgbachi mpaghara mesoo ya.
Shockwave: bụ ọgwụgwọ na-adịghị agbanwe agbanwe, nke na-adịghị emerụ ahụ nke nwere uru nke ịmepụta ume n'èzí ahụ ma na-arụpụta ihe na mpaghara ezubere iche n'ime ime ahụ na-emebighị anụ ahụ gbara ya gburugburu. Ọ na-enwe mmetụta nke ịkwalite metabolism, na-eme ka ọbara na mgbasa nke lymph dịkwuo ike, na-eme ka nri anụ ahụ dịkwuo mma, na-ebelata capillaries egbochiri, na ịtọpụ njikọ anụ ahụ dị nro. Otú ọ dị, ọ malitere n'oge na-agwọ ọrịa styloid stenosis tenosynovitis nke radius, na akụkọ nyocha ya dị ole na ole, a ka na-achọkwa ihe ọmụmụ ndị a na-achịkwa nke ukwuu iji nyekwuo ihe àmà ahụike na-egosi na ọ na-akwalite iji ya na ọgwụgwọ nke ọrịa styloid stenosis tenosynovitis nke radius.
Ọgwụgwọ acupuncture: obere ọgwụgwọ acupuncture bụ usoro ntọhapụ mechiri emechi n'etiti ọgwụgwọ ịwa ahụ na ọgwụgwọ na-abụghị nke ịwa ahụ, site na nsị na mkpochapụ nke ọnya mpaghara, a na-ahapụ adhesions, na ọnyà nke akwara akwara vaskụla na-ebelata nke ọma, na mgbasa ọbara nke anụ ahụ gbara ya gburugburu na-akawanye mma site na mkpali na-akpali akpali, na-ebelata mkpali na mkpali nke mkpali. nke mgbochi mkpali na analgesic.
Ọgwụ ndị China ọdịnala: Radial styloid stenosis tenosynovitis bụ ụdị nke "ọrịa mkpọnwụ ahụ" na ọgwụ nke ala nne, ọrịa ahụ dabere na ụkọ na ọkọlọtọ. N'ihi ọrụ ogologo oge nke nkwonkwo nkwojiaka, oke nrụgide, na-akpata qi mpaghara na ụkọ ọbara, nke a na-akpọ ụkọ mbụ; N'ihi na mpaghara Qi na erughi ọbara, mọzụlụ na veins na-efunahụ nri na-amị amị, na n'ihi mmetụta nke ifufe, oyi na dampness, nke na-eme ka ngọngọ nke Qi na ọbara ọrụ, a na-ahụ na mpaghara ọzịza na mgbu na ọrụ na-amachibidoro, na mkpokọta nke qi na ọbara bụ ihe dị njọ na spasm mpaghara bụ ihe dị njọ karị na spasm mpaghara ahụ bụ ihe mgbu nke mbụ na nkwojiaka, ya mere, ihe mgbu na nkwonkwo ahụ dị njọ karị. nkwonkwo metacarpophalangeal na-akawanye njọ na ụlọ ọgwụ, nke bụ ọkọlọtọ. Achọpụtara ụlọ ọgwụ na ọgwụgwọ moxibustion, ọgwụgwọ ịhịa aka n'ahụ, ọgwụgwọ mpụga nke ọgwụ ndị China ọdịnala na ọgwụgwọ acupuncture nwere ụfọdụ mmetụta ụlọ ọgwụ.
Ọgwụgwọ ịwa ahụ: Ịwa ahụ nke ligament carpal dorsal nke radius na njedebe dị oke bụ otu n'ime ọgwụgwọ maka tenosynovitis stenosis na usoro styloid nke radius. Ọ dị mma maka ndị ọrịa nwere tenosynovitis ugboro ugboro nke radius styloid stenosis, bụ nke na-adịghị arụ ọrụ mgbe ọtụtụ oghere mpaghara na ọgwụgwọ ndị ọzọ na-agbanwe agbanwe, na mgbaàmà ahụ siri ike. Karịsịa na ndị ọrịa nwere tenosynovitis stenotic Advanced, ọ na-ebelata ihe mgbu siri ike na nke na-emegharị emegharị.
Ịwa ahụ ghe oghe ozugbo: Usoro ịwa ahụ a na-emekarị bụ ịmebe ebe ahụ ozugbo na ebe dị nro, kpughee septum akwara azụ azụ nke mbụ, bechapụ n'ọbọ akwara, ma hapụ n'ọbọ akwara ka akwara wee nwee ike ịmịnye kpamkpam n'ime n'ọbọ akwara. Ịwa ahụ a na-emeghe ozugbo na-adị ngwa ngwa, mana ọ na-ebu usoro ihe egwu ịwa ahụ dị ka ọrịa, na n'ihi mwepụ kpọmkwem nke dorsal band band n'oge ịwa ahụ, mgbatị akwara na mmebi nke akwara radial na vein nwere ike ime.
1st septolysis: Usoro ịwa ahụ a anaghị ebipụ n'ọbọ akaị gbajiri agbagọ, ma na-ewepụ cyst ganglion dị na 1st extensor septum ma ọ bụ bepụ septum n'etiti abductor pollicis longus na extensor pollicis brevis iji hapụ 1st dorsal extensor septum. Usoro a yiri ịwa ahụ ghe oghe kpọmkwem, yana ihe dị iche bụ na mgbe e gbuchasịrị eriri nkwado extensor, a na-ahapụ n'ọbọ akwara ma wepụ ya n'ọbọ akwara kama site na mbepụ n'ọbọ akwara. Ọ bụ ezie na subluxation akwara nwere ike ịdị na usoro a, ọ na-echebe 1st dorsal extensor septum ma nwee mmetụta dị ogologo oge dị elu maka nkwụsi ike akwara karịa nhazi nke n'ọbọ akwara ozugbo. Mwepu nke usoro a bụ n'ihi na a naghị ewepụ n'ọbọ akwara ndị gbara ọkpụrụkpụ, na n'ọbọ akwara nwere ike ka na-akpasu iwe, edema, na esemokwu ya na akaị ga-eduga n'ọganihu nke ọrịa ahụ.
Arthroscopic osteofibrous duct augmentation: ọgwụgwọ arthroscopic nwere uru nke obere trauma, usoro ọgwụgwọ dị mkpirikpi, nchekwa dị elu, obere mgbagwoju anya na mgbake ngwa ngwa, na nnukwu uru bụ na eriri nkwado extensor adịghị etinye ya, ọ gaghịkwa enwe nkwụsị aka. Otú ọ dị, a ka nwere arụmụka, ụfọdụ ndị ọkà mmụta kwenyere na ịwa ahụ arthroscopic dị oke ọnụ ma na-ewe oge, na uru ọ bara karịa ịwa ahụ na-emeghe kpọmkwem egosighi nke ọma. Ya mere, ọgwụgwọ arthroscopic anaghị ahọrọ ọtụtụ ndị dọkịta na ndị ọrịa.
Oge nzipu: Ọkt-29-2024
