Styloid stenosis tenosynovitis ndi kutupa kosatheka chifukwa cha ululu ndi kutupa kwa abductor pollicis longus ndi extensor pollicis brevis tendons pa dorsal carpal sheath pa radial styloid process. Zizindikiro zimakula kwambiri ndi kukula kwa chala chachikulu ndi kusintha kwa calimor. Matendawa adanenedwa koyamba ndi dokotala wa opaleshoni waku Switzerland de Quervain mu 1895, kotero radial styloid stenosis tenosynovitis imadziwikanso kuti de Quervain's disease.
Matendawa amapezeka kwambiri mwa anthu omwe amachita zinthu zolimbitsa thupi nthawi zambiri m'manja ndi m'manja, ndipo amadziwikanso kuti "dzanja la amayi" ndi "chala chamasewera". Ndi chitukuko cha intaneti, chiwerengero cha anthu omwe akukhudzidwa ndi matendawa chikuwonjezeka komanso chaching'ono. Ndiye mungazindikire bwanji ndikuchiza matendawa? Zotsatirazi zikupatsani chiyambi chachidule kuchokera kuzinthu zitatu: kapangidwe ka thupi, kuzindikira matenda ndi njira zochiritsira!
I. Kapangidwe ka Thupi
Njira yopangira styloid ya radius ili ndi sulcus yopapatiza, yosaya kwambiri yophimbidwa ndi dorsal carpal ligament yomwe imapanga chigoba cha mafupa. Mtendo wa abductor pollicis longus ndi tendon wa extensor pollicis brevis umadutsa mu chigoba ichi ndikupindika pa ngodya ndikuthera pansi pa fupa loyamba la metacarpal ndi pansi pa phalanx yoyandikana ya chala chachikulu, motsatana (Chithunzi 1). Mtendo ukayenda, pamakhala mphamvu yayikulu yokangana, makamaka pamene kupotoka kwa chigongono cha dzanja kapena kusuntha kwa chala chachikulu, ngodya yopinda imawonjezeka, zomwe zimawonjezera kukangana pakati pa tendon ndi khoma la sheath. Pambuyo polimbikitsa nthawi yayitali, synovium imabweretsa kusintha kotupa monga kutupa ndi hyperplasia, zomwe zimayambitsa kukhuthala, kumamatira kapena kuchepa kwa tendon ndi khoma la sheath, zomwe zimapangitsa kuti stenosis tenosynovitis iwonekere.
Chithunzi 1 Chithunzi cha kapangidwe ka njira ya styloid ya radius
II. Kuzindikira matenda
1. Mbiri ya matenda imapezeka kwambiri kwa azaka zapakati, opaleshoni yamanja, komanso kwa akazi; Kuyamba kwake kumachitika pang'onopang'ono, koma zizindikiro zimatha kuchitika mwadzidzidzi.
2. Zizindikiro: kupweteka komwe kumachitika mu njira ya styloid ya radius, yomwe imatha kufalikira ku dzanja ndi mkono, kufooka kwa chala chachikulu, kutambasula pang'ono kwa chala chachikulu, kuwonjezeka kwa zizindikiro pamene chala chachikulu chikutambasula ndi kupotoka kwa chigongono cha dzanja; Ma nodule omwe amatha kumveka amatha kumveka pa njira ya styloid ya radius, yofanana ndi kutchuka kwa mafupa, yokhala ndi kuuma koonekera.
3.Mayeso a Finkelstein (monga mayeso a fist ulnar deviation test) ndi abwino (monga momwe zasonyezedwera pa Chithunzi 2), chala chachikulu chimapindika ndikugwiridwa m'dzanja, dzanja la ulnar limapotoka, ndipo ululu pa radius styloid process umakula.
4. Kuyezetsa kothandiza: Kuyezetsa kwa X-ray kapena ultrasound yamitundu kungathe kuchitidwa ngati kuli kofunikira kuti kutsimikizire ngati pali vuto la mafupa kapena synovitis. Malangizo a Chithandizo cha Mitundu Yosiyanasiyana ya Styloid Stenosis Tenosynovitis ya Radius Dziwani kuti kuyezetsa kwina kwa thupi kumafunika kuti kusiyanitsa pakati pa osteoarthritis, matenda a nthambi ya pamwamba ya mitsempha ya radial, ndi forearm cruciate syndrome panthawi yodziwira matenda.
III. Chithandizo
Chithandizo chokhazikika Chithandizo cha kuletsa kuyenda kwa thupi: Poyambirira, odwala amatha kugwiritsa ntchito chothandizira chakunja kuti aletse kuyenda kwa gawo lokhudzidwa kuti achepetse zochitika zapafupi ndikuchepetsa kukangana kwa tendon mu tendon sheath kuti akwaniritse cholinga cha chithandizo. Komabe, kuletsa kuyenda sikungatsimikizire kuti gawo lokhudzidwalo lili pamalo ake, ndipo kuletsa kuyenda kwa nthawi yayitali kungayambitse kuuma kwa kuyenda kwa nthawi yayitali. Ngakhale kuti njira zina zothandizira kuletsa kuyenda zimagwiritsidwa ntchito m'machitidwe azachipatala, kugwira ntchito kwa chithandizocho kukupitilirabe kutsutsana.
Chithandizo cha m'deralo chotseka: Monga chithandizo chodziwika bwino cha chithandizo chamankhwala, chithandizo cha m'deralo chotseka chimatanthauza jakisoni wamkati pamalo opweteka kuti akwaniritse cholinga cha mankhwala oletsa kutupa. Chithandizo cha m'deralo chingathe kulowetsa mankhwala m'dera lopweteka, thumba la chidendene cha mafupa, thunthu la mitsempha ndi ziwalo zina, zomwe zimachepetsa kutupa ndikuchepetsa ululu ndikuchepetsa kupweteka kwakanthawi kochepa, komanso zimathandiza kwambiri pochiza zilonda zam'deralo. Chithandizochi chimakhala ndi triamcinolone acetonide ndi lidocaine hydrochloride. Jakisoni wa sodium hyaluronate angagwiritsidwenso ntchito. Komabe, mahomoni amatha kukhala ndi zovuta monga kupweteka pambuyo pa jakisoni, utoto wa khungu, kuchepa kwa minofu ya m'deralo, kuvulala kwa mitsempha ya radial, komanso kuchuluka kwa shuga m'magazi. Zotsutsana zazikulu ndi allergy ya mahomoni, odwala apakati ndi oyamwitsa. Sodium hyaluronate ikhoza kukhala yotetezeka ndipo ingalepheretse zipsera za zomatira kuzungulira tendon ndikulimbikitsa kuchira kwa tendon. Zotsatira zachipatala za chithandizo cha m'deralo ndizodziwikiratu, koma pali malipoti azachipatala a necrosis ya zala zomwe zimachitika chifukwa cha jakisoni wosayenera wam'deralo (Chithunzi 3).
Chithunzi 3 Kutsekeka pang'ono kumabweretsa kufalikira kwa zala za m'manja: A. Khungu la dzanja ndi losakhazikika, ndipo B, C. Gawo lapakati la chala cham'manja lili patali kwambiri, ndipo zala za m'manja ndi zotupa
Chenjezo pa chithandizo cha occlusive therapy pochiza radius styloid stenosis tenosynovitis: 1) Malo ake ndi olondola, ndipo syringe iyenera kuchotsedwa musanapereke mankhwala kuti mutsimikizire kuti singano ya jakisoni siilowa m'mitsempha yamagazi; 2) Kuletsa bwino mwendo wa mwendo wokhudzidwa kuti mupewe kuchita masewera olimbitsa thupi msanga; 3) Pambuyo pa jakisoni wa hormone, nthawi zambiri pamakhala ululu wosiyanasiyana, kutupa, komanso kupweteka kwambiri, komwe nthawi zambiri kumazimiririka pakatha masiku 2-3, ngati kupweteka kwa zala ndi khungu lakuda zikuwonekera, chithandizo cha antispasmodic ndi anticoagulant chiyenera kuperekedwa mwachangu, ndipo angiography iyenera kuchitidwa kuti iwonetse bwino ngati n'kotheka, ndipo kufufuza kwa mitsempha yamagazi kuyenera kuchitika mwachangu momwe zingathere ngati kuli kofunikira, kuti musachedwetse vutoli; 4) Zotsutsana ndi mahomoni monga kuthamanga kwa magazi, matenda a shuga, matenda a mtima, ndi zina zotero, siziyenera kuchiritsidwa ndi occlusion yapafupi.
Shockwave: ndi mankhwala osalowerera omwe ali ndi ubwino wopanga mphamvu kunja kwa thupi ndikupanga zotsatira m'malo omwe akufunidwa mkati mwa thupi popanda kuwononga minofu yozungulira. Amakhala ndi mphamvu yolimbikitsa kagayidwe kachakudya, kulimbitsa magazi ndi kuyenda kwa lymphatic, kukonza zakudya za minofu, kumasula mitsempha yotsekeka, komanso kumasula zomatira zofewa za minofu. Komabe, idayamba mochedwa pochiza styloid stenosis tenosynovitis ya radius, ndipo malipoti ake ofufuza ndi ochepa, ndipo maphunziro akuluakulu olamulidwa mwachisawawa akufunikabe kuti apereke umboni wambiri wazachipatala wozikidwa pa umboni kuti alimbikitse kugwiritsidwa ntchito kwake pochiza matenda a styloid stenosis tenosynovitis ya radius.
Chithandizo cha Acupuncture: chithandizo cha acupuncture chaching'ono ndi njira yotseguka yotulutsira pakati pa chithandizo cha opaleshoni ndi chithandizo chosagwiritsa ntchito opaleshoni, kudzera mu kupukuta ndi kuchotsa zilonda za m'deralo, zomatira zimatulutsidwa, ndipo kutsekeka kwa mitsempha yamagazi kumachepetsedwa bwino, ndipo kuyenda kwa magazi m'thupi lozungulira kumawonjezeka kudzera mu kukondoweza kwa acupuncture, kuchepetsa kutupa, ndikukwaniritsa cholinga choletsa kutupa komanso kupha ululu.
Mankhwala achikhalidwe achi China: Radial styloid stenosis tenosynovitis ndi imodzi mwa matenda a "paralysis syndrome" mu mankhwala a dziko lakwawo, ndipo matendawa amachokera ku kusowa ndi muyezo. Chifukwa cha ntchito yayitali ya chigongono, kupsinjika kwambiri, zomwe zimapangitsa kuti qi ndi magazi zisamayende bwino, izi zimatchedwa kusowa koyambirira; Chifukwa cha qi ndi kusowa kwa magazi m'deralo, minofu ndi mitsempha zimasowa chakudya komanso zimaterera, ndipo chifukwa cha kumva mphepo, kuzizira ndi chinyezi, zomwe zimawonjezera kutsekeka kwa qi ndi magazi, zikuwoneka kuti kutupa ndi ululu ndi ntchito zapafupi ndizochepa, ndipo kusonkhana kwa qi ndi magazi kumakhala koopsa kwambiri ndipo kupindika kwapafupi kumakhala koopsa kwambiri, kotero zapezeka kuti kupweteka kwa chigongono chosunthika ndi chigongono choyamba cha metacarpophalangeal kumakulirakulira kuchipatala, chomwe ndi muyezo. Zapezeka kuti chithandizo cha moxibustion, chithandizo cha massage, chithandizo chakunja cha mankhwala achikhalidwe achi China ndi chithandizo cha acupuncture zimakhala ndi zotsatira zina zachipatala.
Chithandizo cha opaleshoni: Kuduladula kwa dorsal carpal ligament ya radius ndi kuchotsa pang'ono ndi njira imodzi yochizira stenosis tenosynovitis mu njira ya styloid ya radius. Ndi yoyenera kwa odwala omwe ali ndi tenosynovitis yobwerezabwereza ya radius styloid stenosis, yomwe yakhala yosagwira ntchito pambuyo potseka malo ambiri ndi mankhwala ena osungira, ndipo zizindikiro zake zimakhala zoopsa. Makamaka kwa odwala omwe ali ndi stenotic advanced tenosynovitis, imachepetsa ululu waukulu komanso wotsutsa.
Opaleshoni yotseguka mwachindunji: Njira yodziwika bwino yochitira opaleshoni ndi kudula mwachindunji pamalo ofewa, kuonetsa septum yoyamba ya minofu ya dorsal, kudula tendon sheath yokhuthala, ndikutulutsa tendon sheath kuti tendon itha kutsetsereka momasuka mkati mwa tendon sheath. Opaleshoni yotseguka mwachindunji imachitika mwachangu, koma imakhala ndi zoopsa zingapo monga matenda, ndipo chifukwa chochotsa mwachindunji dorsal support band panthawi ya opaleshoni, tendon dislocation ndi kuwonongeka kwa radial nerve ndi vein zitha kuchitika.
Kutupa koyamba kwa tendon: Njira yopangira opaleshoniyi sidula sheath yokhuthala ya tendon, koma imachotsa ganglion cyst yomwe imapezeka mu 1st extensor septum kapena kudula septum pakati pa abductor pollicis longus ndi extensor pollicis brevis kuti itulutse 1st dorsal extensor septum. Njirayi ndi yofanana ndi opaleshoni yotseguka mwachindunji, kusiyana kwakukulu ndikuti mutadula band yothandizira extensor, tendon sheath imatulutsidwa ndipo tendon sheath imachotsedwa m'malo moduladula tendon sheath yokhuthala. Ngakhale kuti tendon subluxation ikhoza kukhalapo mu njira iyi, imateteza 1st dorsal extensor septum ndipo ili ndi mphamvu yayitali yokhazikika ya tendon kuposa kudula mwachindunji tendon sheath. Kuipa kwa njira iyi makamaka chifukwa chakuti tendon sheath yokhuthala siichotsedwa, ndipo tendon sheath yokhuthala ikhoza kukhalabe yotupa, kutupa, ndi kukangana ndi tendon kudzapangitsa kuti matendawa abwererenso.
Kukulitsa njira yolumikizira mafupa a mafupa: chithandizo cha arthroscopic chili ndi ubwino wochepa kuvulala, nthawi yochepa yochizira, chitetezo champhamvu, zovuta zochepa komanso kuchira mwachangu, ndipo ubwino waukulu ndi wakuti lamba wothandizira wa extensor sunadulidwe, ndipo sipadzakhala kusokonekera kwa tendon. Komabe, pakadalibe mkangano, ndipo akatswiri ena amakhulupirira kuti opaleshoni ya arthroscopic ndi yokwera mtengo komanso imatenga nthawi, ndipo ubwino wake kuposa opaleshoni yotseguka mwachindunji siwowonekera mokwanira. Chifukwa chake, chithandizo cha arthroscopic nthawi zambiri sichisankhidwa ndi madokotala ndi odwala ambiri.
Nthawi yotumizira: Okutobala-29-2024
