Styloid stenosis tenosynovitis ndi kutupa kwa aseptic komwe kumachitika chifukwa cha ululu ndi kutupa kwa abductor pollicis longus ndi extensor pollicis brevis tendons pa dorsal carpal sheath pa radial styloid process. Zizindikiro zimakulirakulira ndi kukulitsa chala chachikulu komanso kupatuka kwa calimor. Matendawa adanenedwa koyamba ndi dokotala waku Switzerland de Quervain mu 1895, kotero kuti radial styloid stenosis tenosynovitis imadziwikanso kuti de Quervain's disease.
Matendawa amapezeka kwambiri mwa anthu omwe amagwira ntchito pafupipafupi pazanja ndi zala za palmar, ndipo amadziwikanso kuti "dzanja la amayi" ndi "chala chamasewera". Ndi chitukuko cha intaneti, chiwerengero cha anthu omwe akukhudzidwa ndi matendawa chikuwonjezeka komanso chochepa. Ndiye momwe mungazindikire ndi kuchiza matendawa? Zotsatirazi zidzakupatsani chiyambi chachidule kuchokera kuzinthu zitatu: mawonekedwe a anatomical, matenda achipatala ndi njira zothandizira!
I.Anatomy
Njira ya styloid ya radius ili ndi sulcus yopapatiza, yosazama yomwe imakutidwa ndi dorsal carpal ligament yomwe imapanga fupa la fibrous sheath. The abductor pollicis longus tendon ndi extensor pollicis brevis tendon imadutsa mchimakechi ndikupinda pang'onopang'ono ndikutha pamunsi pa fupa loyamba la metacarpal ndi m'munsi mwa proximal phalanx ya chala chachikulu, motsatana (Chithunzi 1). Pamene tendon ikugwedezeka, pamakhala kugwedezeka kwakukulu, makamaka pamene kupatuka kwa dzanja lamanja kapena kusuntha kwa chala chachikulu, nsonga yopindika imawonjezeka, ndikuwonjezera kukangana pakati pa tendon ndi khoma la sheath. Pambuyo pakukondoweza kwanthawi yayitali kwanthawi yayitali, synovium imabweretsa kusintha kotupa monga edema ndi hyperplasia, zomwe zimapangitsa kukhuthala, kumamatira kapena kuchepera kwa tendon ndi khoma la sheath, zomwe zimapangitsa kuti pakhale mawonekedwe a stenosis tenosynovitis.
Mkuyu.1 Chithunzi cha anatomical cha styloid process of the radius
II.Kuzindikira kwachipatala
1.Mbiri yachipatala imakhala yofala kwambiri pakati pa zaka zapakati, ogwira ntchito pamanja, komanso ambiri mwa amayi; Imayamba pang'onopang'ono, koma zizindikiro zimatha kuchitika mwadzidzidzi.
2.Zizindikiro: zowawa zamtundu wamtundu wa styloid ndondomeko ya radius, yomwe imatha kutulutsa dzanja ndi mkono, kufooka kwa thupi, kuwonjezereka kwa chala chachikulu, kuwonjezereka kwa zizindikiro pamene kukula kwa chala chachikulu ndi kupatuka kwa mkono; Manodulo omveka amatha kukhala omveka pamapangidwe a styloid a radius, ofanana ndi fupa lapamwamba, ndi kukoma mtima kodziwika.
3.Mayeso a Finkelstein (ie, kuyesa kwa nkhonya kwa ulnar) ndi zabwino (monga momwe tawonetsera pa Chithunzi 2), chala chachikulu chimasinthasintha ndikugwiridwa m'manja, mkono wapakhosi umapatuka, ndipo kupweteka kwa radius styloid kumakulirakulira.
4.Kufufuza kothandizira: Kufufuza kwa X-ray kapena mtundu wa ultrasound kungathe kuchitidwa ngati kuli kofunikira kuti atsimikizire ngati pali vuto la mafupa kapena synovitis. The Guidelines for Multidisciplinary Treatment of Styloid Stenosis Tenosynovitis of the Radius Dziwani kuti kuyezetsa kwina kwa thupi kumafunika kusiyanitsa pakati pa osteoarthritis, kusokonezeka kwa nthambi yapamwamba ya mitsempha yozungulira, ndi matenda a forearm cruciate panthawi ya matenda.
III.Kuchiza
Conservative therapyLocal immobilization therapy: Kumayambiriro koyambirira, odwala amatha kugwiritsa ntchito chingwe chokhazikika chakunja kuti asasunthike mwendo womwe wakhudzidwa kuti achepetse zochitika zakomweko ndikuchepetsa kukangana kwa tendon mu sheath ya tendon kuti akwaniritse cholinga cha chithandizo. Komabe, kusasunthika sikungatsimikizire kuti chiwalo chokhudzidwacho chilipo, ndipo kusasunthika kwa nthawi yaitali kungayambitse kuuma kwa nthawi yaitali. Ngakhale kuti chithandizo cha immobilization-mothandizidwa ndi mankhwala ena chimagwiritsidwa ntchito mwamphamvu m'zachipatala, mphamvu ya chithandizo imakhalabe yotsutsana.
Thandizo la kutsekeka kwa m'deralo: Monga chithandizo chodziwikiratu chothandizira chithandizo chamankhwala, chithandizo cham'deralo cha occlusion chimatanthawuza jekeseni wa intrathecal pamalo opweteka apafupi kuti akwaniritse cholinga cha anti-inflammatory. Occlusive mankhwala akhoza jekeseni mankhwala m`dera ululu, olowa m`chikwama thumba, mitsempha thunthu ndi mbali zina, amene angathe kuchepetsa kutupa ndi kuthetsa ululu ndi kuthetsa spasms mu nthawi yochepa, ndi mbali yaikulu pa chithandizo cha zotupa m`deralo. Thandizo limapangidwa makamaka ndi triamcinolone acetonide ndi lidocaine hydrochloride. Majekeseni a sodium hyaluronate angagwiritsidwenso ntchito. Komabe, mahomoni amatha kukhala ndi zovuta monga kupweteka kwapambuyo kubayidwa, kusinthika kwamtundu wapakhungu, atrophy yamkati yamkati, kuwonongeka kwa mitsempha yamagazi, komanso kuchuluka kwa shuga m'magazi. Waukulu contraindications ndi timadzi ziwengo, oyembekezera ndi kuyamwitsa odwala. Sodium hyaluronate ikhoza kukhala yotetezeka ndipo imatha kuletsa zomatira kuzungulira tendon ndikulimbikitsa machiritso a tendon. Zotsatira zachipatala za occlusive therapy ndizodziwikiratu, koma pali malipoti azachipatala a chala necrosis chifukwa cha jekeseni wolakwika wamba (Chithunzi 3).
Chithunzi 3 Kutsekeka pang'ono kumayambitsa necrosis ya zala zala zala: A. Khungu la dzanja limakhala lachigamba, ndi B, C. Gawo lapakati la chala cholozera liri kutali, ndipo zala ndi necrosis.
Kusamala kwa occlusive mankhwala pa matenda a utali wozungulira styloid stenosis tenosynovitis: 1) udindo ndi yolondola, ndi syringe ayenera kuchotsedwa pamaso jekeseni mankhwala kuonetsetsa kuti jekeseni singano si kudutsa chotengera cha magazi; 2) Kusasunthika koyenera kwa chiwalo chokhudzidwa kuti tipewe kuchita masewera olimbitsa thupi msanga; 3) Pambuyo pa jekeseni wa mahomoni occlusion, nthawi zambiri pamakhala ululu wosiyanasiyana, kutupa, komanso kuwonjezereka kwa ululu, zomwe zimasowa masiku 2 ~ 3, ngati kupweteka kwa chala ndi kunjenjemera kumawonekera, mankhwala a antispasmodic ndi anticoagulant ayenera kuperekedwa mwamsanga, ndipo angiography iyenera kuchitidwa kuti adziwe bwino ngati n'kotheka, ndi kufufuza kwa mitsempha kuyenera kuchitika mwamsanga, ngati n'kotheka; 4) Zotsutsana ndi mahomoni monga matenda oopsa, matenda a shuga, matenda a mtima, ndi zina zotero, siziyenera kuchitidwa ndi kutsekeka kwanuko.
Shockwave: ndi mankhwala osamalidwa, osasokoneza omwe ali ndi ubwino wopangira mphamvu kunja kwa thupi ndi kutulutsa zotsatira m'madera omwe akukhudzidwa mkati mwa thupi popanda kuwononga minofu yozungulira. Imalimbitsa kagayidwe kachakudya, kulimbitsa ma circulation a magazi ndi ma lymphatic, kupititsa patsogolo kadyedwe ka minofu, kuchotsa ma capillaries otsekeka, komanso kumasula zomata za minofu yofewa. Komabe, idayamba mochedwa pochiza styloid stenosis tenosynovitis ya utali wozungulira, ndipo malipoti ake ofufuza ndi ochepa, ndipo maphunziro akuluakulu osasinthika amafunikirabe kuti apereke umboni wochuluka wamankhwala wozikidwa pa umboni kuti ulimbikitse kugwiritsidwa ntchito kwake pochiza matenda a styloid stenosis tenosynovitis of the radius.
Chithandizo cha acupuncture: chithandizo chaching'ono cha acupuncture ndi njira yotsekeka yotulutsa pakati pa chithandizo cha opaleshoni ndi chithandizo chosapanga opaleshoni, kudzera pakupukuta ndi kupukuta zilonda zam'deralo, zomatira zimatulutsidwa, ndipo kutsekeka kwa mitsempha ya mitsempha kumatsitsimutsidwa bwino, ndipo kufalikira kwa magazi kwa minyewa yozungulira kumayenda bwino kudzera mu kukondoweza kwabwino, kutukusira kwa minyewa yozungulira, kukondoweza komanso kutupa. cholinga cha anti-yotupa ndi analgesic.
Traditional Chinese mankhwala: Radial styloid stenosis tenosynovitis ali m'gulu la "paralysis syndrome" mu mankhwala a motherland, ndipo matendawa amachokera ku kusowa ndi muyezo. Chifukwa cha ntchito ya nthawi yayitali ya mgwirizano wa dzanja, kupsyinjika kwakukulu, zomwe zimapangitsa kuti qi ndi kusowa kwa magazi m'deralo, izi zimatchedwa kusowa koyambirira; Chifukwa cha kuchepa kwa qi ndi magazi, minofu ndi mitsempha imatayika mu chakudya komanso poterera, ndipo chifukwa cha kumverera kwa mphepo, kuzizira ndi chinyezi, zomwe zimawonjezera kutsekeka kwa qi ndi ntchito ya magazi, zimawoneka kuti kutupa ndi zowawa ndi ntchito ndizoletsedwa, ndipo kudzikundikira kwa qi ndi magazi kumakhala koopsa kwambiri, ndipo kupweteka kwapafupi kumakhala koopsa kwambiri. Kulumikizana kwa dzanja ndi gawo loyamba la metacarpophalangeal likukulirakulira kuchipatala, chomwe ndi muyezo. Zachipatala anapeza kuti moxibustion therapy, kutikita minofu, chithandizo chakunja cha mankhwala achi China ndi acupuncture ali ndi zotsatira zina zachipatala.
Chithandizo cha Opaleshoni: Opaleshoni yodula pamtsempha wa dorsal carpal ligament ya utali wozungulira ndi kudula pang'ono ndi imodzi mwa njira zochizira stenosis tenosynovitis mu styloid process of radius. Ndiwoyenera kwa odwala omwe ali ndi tenosynovitis yobwerezabwereza ya radius styloid stenosis, yomwe yakhala yosagwira ntchito pambuyo pa kutsekedwa kwapadera kwapafupi ndi mankhwala ena owonetsetsa, ndipo zizindikiro zimakhala zovuta. Makamaka odwala ndi stenotic patsogolo tenosynovitis, izo relieves ululu waukulu ndi refractory.
Opaleshoni yotseguka mwachindunji: Njira yochitira opaleshoni yodziwika bwino ndiyo kupanga chodulira chachindunji pamalo anthete, kuwonetsa septum yoyamba ya dorsal minofu, kudula mchira wa tendon wokhuthala, ndikumasula sheath ya tendon kotero kuti tendon imatha kuyenda momasuka mkati mwa sheath ya tendon. Opaleshoni yachindunji yotseguka imakhala yofulumira, koma imakhala ndi zovuta zingapo za opaleshoni monga matenda, ndipo chifukwa cha kuchotsedwa kwachindunji kwa gulu lothandizira la dorsal panthawi ya opaleshoni, kusokonezeka kwa tendon ndi kuwonongeka kwa mitsempha yowonongeka ndi mitsempha imatha kuchitika.
1st septolysis: Njira yopangira opaleshoniyi simadula mchira wokhuthala wa tendon, koma imachotsa chiphuphu cha ganglion chomwe chimapezeka mu 1st extensor septum kapena kudula septum pakati pa abductor pollicis longus ndi extensor pollicis brevis kuti amasule 1st dorsal extensor septum. Njirayi ndi yofanana ndi opaleshoni yotsegula mwachindunji, kusiyana kwakukulu ndiko kuti mutatha kudula gulu lothandizira la extensor, sheath ya tendon imatulutsidwa ndipo sheath ya tendon imachotsedwa m'malo mwa kudulidwa kwa tendon sheath. Ngakhale kuti tendon subluxation ikhoza kukhalapo mwa njira iyi, imateteza 1st dorsal extensor septum ndipo imakhala ndi mphamvu yayitali ya nthawi yayitali ya kukhazikika kwa tendon kusiyana ndi kubwereza kwachindunji kwa tendon sheath. Kuipa kwa njira imeneyi makamaka chifukwa chakuti unakhuthala tendon m'chimake si kuchotsedwa, ndipo unakhuthala tendon m'chimake akadali yotupa, edema, ndi mikangano ndi tendon zidzachititsa kuti matenda kubweranso.
Arthroscopic osteofibrous duct augmentation: chithandizo cha arthroscopic chimakhala ndi ubwino wochepetsera kupwetekedwa mtima, njira yachidule ya mankhwala, chitetezo chapamwamba, zovuta zochepa komanso kuchira msanga, ndipo phindu lalikulu ndiloti lamba wothandizira extensor sanadulidwe, ndipo sipadzakhala kusokonezeka kwa tendon. Komabe, padakali kutsutsana, ndipo akatswiri ena amakhulupirira kuti opaleshoni ya arthroscopic ndi yokwera mtengo komanso imatenga nthawi, ndipo ubwino wake pa opaleshoni yotsegula mwachindunji sizowoneka mokwanira. Chifukwa chake, chithandizo cha arthroscopic nthawi zambiri sichimasankhidwa ndi madokotala ndi odwala ambiri.
Nthawi yotumiza: Oct-29-2024
