基于解剖结构的桡骨茎突狭窄性腱鞘炎研究进展
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摘要
桡骨茎突狭窄性腱鞘炎又称de Quervain病,是第1伸肌室内的拇长展肌及拇短伸肌在滑动时受阻力产生疼痛,桡骨茎突狭窄性腱鞘炎的发病与其解剖结构是密切相关的,通过症状及体征与辅助检查能较好的确诊该病。轻微的桡骨茎突狭窄性腱鞘炎通过休息、支具限制活动及口服药物等就能得到改善,中医疗法及理疗也对该病有一定帮助。针刀疗法作为中医微创手术,是一种介于保守治疗与开放性手术之间的梯级治疗,通过松解第1伸肌室来解除卡压。类固醇注射是该病临床较常见的治疗方式,其疗效与注射的精准程度有关同时受到患者基于解剖结构变异的病情严重程度的影响。在超声下识别第1伸肌室内的间隔能帮助患者更好的选择保守疗法或手术治疗。手术疗法能更彻底从解剖结构上改善桡骨茎突狭窄性腱鞘炎的病情,临床应注意术式的选择以减少手术并发症的产生。本文从解剖结构方面论述该病的发病、诊断及治疗,主要分析各疗法的治疗靶点及临床选择运用情况,旨在为桡骨茎突狭窄性腱鞘炎的诊断和治疗提供参考。
Stenosing tenosynovitis of styloid process of radius(de Quervain's disease) which abductor pollicis longus and extensor pollicis brevis in the first extensor chamber are affected by resistance when sliding, the incidence is affected by anatomical variations. Symptoms, signs and auxiliary examinations can diagnose the disease. Slight dQS can be improved by rest,brace,restriction activities, and oral medications. Chinese medicine and physiotherapy also reduce the disease. Needle knife therapy is a Traditional Chinese medicine minimally invasive surgery, which is also a step-by-step treatment between conservative treatment and open surgery to loosening the compression of the first extensor chamber. Steroid injection is a more common treatment in this disease,and its efficacy is related to the accuracy of the injection and is affected by the severity of the patient's anatomical variation. Identifying the spacing within the first extensor chamber under ultrasound can help patients better choose conservative or surgical treatment. Surgical treatment can more completely change the condition of dQD from anatomical structure, and clinical should pay attention to the choice of surgical procedure to improve the efficacy and reduce the occurrence of surgical complications. This article discusses the pathogenesis, diagnosis and treatment of the disease from the perspective of anatomical structure. It mainly analyzes the therapeutic targets and the clinical application, which aims to provide reference for the diagnosis and treatment of de Quervain disease.
Stenosing tenosynovitis of styloid process of radius(de Quervain's disease) which abductor pollicis longus and extensor pollicis brevis in the first extensor chamber are affected by resistance when sliding, the incidence is affected by anatomical variations. Symptoms, signs and auxiliary examinations can diagnose the disease. Slight dQS can be improved by rest,brace,restriction activities, and oral medications. Chinese medicine and physiotherapy also reduce the disease. Needle knife therapy is a Traditional Chinese medicine minimally invasive surgery, which is also a step-by-step treatment between conservative treatment and open surgery to loosening the compression of the first extensor chamber. Steroid injection is a more common treatment in this disease,and its efficacy is related to the accuracy of the injection and is affected by the severity of the patient's anatomical variation. Identifying the spacing within the first extensor chamber under ultrasound can help patients better choose conservative or surgical treatment. Surgical treatment can more completely change the condition of dQD from anatomical structure, and clinical should pay attention to the choice of surgical procedure to improve the efficacy and reduce the occurrence of surgical complications. This article discusses the pathogenesis, diagnosis and treatment of the disease from the perspective of anatomical structure. It mainly analyzes the therapeutic targets and the clinical application, which aims to provide reference for the diagnosis and treatment of de Quervain disease.
引文
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[2]Petit Le Manac'h A,Roquelaure Y,Ha C,Bodin J,et al.Risk factors for de Quervain's disease in a French working population[J].Scand J Work Environ Health,2011,37(5):394-401.
[3]Stahl S,Vida D,Meisner C,et al.Systematic review and meta analysis on the work related cause of de Quervain tenosynovitis:a critical appraisal of its recognition as an occupational disease[J].Plast Reconstr Surg,2013,132(6):1479-1491.
[4]Stahl S,Vida D,Meisner C,et al.Work related etiology of de Quervain's tenosynovitis:a case control study with prospectively collected data[J].BMC Musculoskelet Disord,2015,16:126.
[5]Kay NR.De Quervain's disease.Changing pathology or changing perception[J].J Hand Surg Br,2000,25(1):65-69.
[6]Kuo YL,Hsu CC,Kuo LC,et al.Inflammation is present in de Quervain Disease-correlation study between biochemical and histopathological evaluation[J].Ann Plast Surg,2015,74(Suppl 2):S146-S151.
[7]Shen PC,Wang PH,Wu PT,et al.The estrogen receptorβexpression in De Quervain's disease[J].Int J Mol Sci,2015,16(11):26452-26462.
[8]Alemohammad AM,Yazaki N,Morris RP,et al.Thumb interphalangeal joint extension by the extensor pollicis brevis:association with a subcompartment and de Quervain's disease[J].J Hand Surg Am,2009,34(4):719-723.
[9]Kulthanan T,Chareonwat B.Variations in abductor pollicis longus and extensor pollicis brevis tendons in the Quervain syndrome:a surgical and anatomical study[J].Scand J Plast Reconstr Surg Hand Surg,2007,41(1):36-38.
[10]Sugiura S,Matsuura Y,Kuniyoshi K,et al.Anatomic study of the first extensor compartment and the relationship between the extensortendon width and its distal insertion[J].Surg Radiol Anat,2017,39(11):1223-1226.
[11]Alemohammad AM,Yazaki N,Morris RP,et al.Thumb interphalangeal joint extension by the extensor pollicis brevis:association with a subcompartment and de Quervain's disease[J].J Hand Surg Am,2009,34(4):719-723.
[12]Sato J,Ishii Y,Noguchi H.Ultrasonographic evaluation of the prevalence of an intracompartmental septum in patients with de Quervain's disease[J].Orthopedics,2016,39(2):112-116.
[13]Gousheh J,Yavari M,Arasteh E.Division of the first dorsal compartment of the hand into two separated canals:rule or exception[J].Arch Iran Med,2009,12(1):52-54.
[14]Gurses IA,Coskun O,Gayretli O,et al.The anatomy of the fibrous and osseous components of the first extensor compartment of the wrist:a cadaveric study[J].Surg Radiol Anat,2015,37(7):773-777.
[15]Hoch J,Fritsch H,Lewejohann S.Congenital or acquired disposition of the separate compartment of the extensor pollicis brevistendon associated with stenosing tendovaginitis(de Quervain's disease)Macroanatomical and fetal plastinationhistological studies of the first compartment of the wrist[J].Ann Anat,2004,186(4):305-310.
[16]Xiao L,Li YK,Ye GH,et al.Variations in the extensor grooves on the radial styloid process in Chinese population[J].Surg Radiol Anat,2013,35(1):49-53.
[17]Gurses IA,Turkay R,Inci E,et al.Sex differences in the radial grooves in the first extensor compartment[J].Skeletal Radiol,2016,45(7):955-958.
[18]Huisstede BM,Coert JH,Fridén J,et al.Consensus on a multidisciplinary treatment guideline for de Quervain disease:results from the European HANDGUIDE study[J].Phys Ther,2014,94(8):1095-1110.
[19]Kutsumi K,Amadio PC,Zhao C,et al.Finkelstein's test:a biomechanical analysis[J].J Hand Surg Am,2005,30(1):130-135.
[20]单忠林,金驰,曹同军,等.Finkelstein征在桡骨茎突部狭窄性腱鞘炎诊断中的意义[J].中医正骨,2008,20(7):38-38.SHAN ZL,JIN C,CAO TJ,et al.Significance of Finkelstein sign in the diagnosis of stenosing tenosynovitis of the styloid process of radius[J].Zhong Yi Zheng Gu,2008,20(7):38-38.Chinese.
[21]Anderson SE,Steinbach LS,De Monaco D,et al."Baby wrist":MRI of an overuse syndrome in mothers[J].AJR Am J Roentgenol,2004,182(3):719-724.
[22]Leslie WD.The scintigraphic appearance of de Quervain tenosynovitis[J].Clin Nucl Med,2006,31(10):602-604.
[23]Diop AN,Ba Diop S,Sane JC,et al.Role of US in the management of de Quervain's tenosynovitis:review of 22 cases[J].J Radiol,2008,89(9 Pt 1):1081-1084.
[24]De Keating Hart E,Touchais S,Kerjean Y,et al.Presence of an intracompartmental septum detected by ultrasound is associated with the failure of ultrasound guided steroid injection in de Quervain's syndrome[J].J Hand Surg Eur Vol,2016,41(2):212-219.
[25]Kwon BC,Choi SJ,Koh SH,et al.Sonographic identification of the intracompartmental septum in de Quervain's disease[J].Clin Orthop Relat Res,2010,468(8):2129-2134.
[26]Turkay R,Inci E,Aydeniz B,et al.Shear wave elastography findings of de Quervain tenosynovitis[J].Eur J Radiol,2017,95:192-196.
[27]Sato J,Ishii Y,Noguchi H.Clinical and ultrasound features in patients with intersection syndrome or de Quervain's disease[J].J Hand Surg Eur Vol,2016,41(2):220-225.
[28]Abe Y,Tsue K,Nagai E,et al.Extensor pollicis longus tenosynovitis mimicking de Quervain's disease because of its course through the first extensor compartment:a report of 2 cases[J].J Hand Surg Am,2004,29(2):225-229.
[29]Anoumou MN,Kouame M,Daix T,et al.Tuberculosis tenosynovitis of the flexor tendons in the wrist:a case report[J].Acta Orthop Traumatol Turc,2014,48(6):690-692.
[30]Chloros GD,Themistocleous GS,Papagelopoulos PJ,et al.Osteoid osteoma of the radial styloid mimicking de quervain tenosynovitis[J].South Med J,2007,100(10):1045-1047.
[31]Agirman M,Tolu S,Baskan O,et al.Brachial artery thrombosis mimicking de Quervain's syndrome:a case report[J].Turkish JPhysical Medicine Rehabilitation,2017,63(3):272-274.
[32]Chang KV,Hung CY,魻zcakar L.Snapping thumb and superficial radial nerve entrapment in de Quervain disease:ultrasound imaging/guidance revisited[J].Pain Med,2015,16(11):2214-2215.
[33]Chen YM,Chen HH,Chen YH,et al.A comparison of safety profiles of tumour necrosis factorαinhibitors and rituximab therapy in patients with rheumatoid arthritis and chronic hepatitis C[J].Ann Rheum Dis,2015,74(3):626-627.
[34]Peters Veluthamaningal C,Winters JC,Groenier KH,et al.Randomised controlled trial of local corticosteroid injections for de Quervain's tenosynovitis in general practice[J].BMC Musculoskelet Disord,2009,10:131.
[35]Zingas C,Failla JM,Van Holsbeeck M.Injection accuracy and clinical relief of de Quervain's tendinitis[J].J Hand Surg Am,1998,23(1):89-96.
[36]Mirzanli C,Ozturk K,Esenyel CZ,et al.Accuracy of intrasheath injection techniques for de Quervain's disease:a cadaveric study[J].J Hand Surg Eur Vol,2012,37(2):155-160.
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