Styloid stenosis tenosynovitis wani kumburi ne na aseptic wanda ke haifar da ciwo da kumburi na abductor pollicis longus da extensor pollicis brevis tendons a cikin dorsal carpal sheath a tsarin radial styloid. Alamun sun yi muni tare da tsawaita babban yatsan yatsa da karkatar da calimor. Likitan fiɗa na Switzerland de Quervain ne ya fara ba da rahoton cutar a cikin 1895, don haka radial styloid stenosis tenosynovitis kuma ana kiranta cutar de Quervain.
Cutar ta fi kamari a cikin mutanen da ke yawan yin ayyukan hannu da na dabino, kuma ana kiranta da "hannun uwa" da "yatsar wasa". Tare da haɓaka Intanet, adadin mutanen da cutar ta shafa yana ƙaruwa kuma ƙanana. To ta yaya ake gano cutar da kuma magance wannan cuta? Masu zuwa za su ba ku taƙaitaccen gabatarwa daga bangarori uku: tsarin jiki, ganewar asibiti da hanyoyin magani!
I. Anatomy
Tsarin styloid na radius yana da kunkuntar sulcus mai zurfi, wanda aka rufe da ligament na carpal na dorsal wanda ke samar da kullin fibrous na kashi. Satar polycis longus tendon da extensor pollicis brevis tendon suna wucewa ta wannan kube kuma su ninka a kusurwa kuma su ƙare a gindin kashi na metacarpal na farko da gindin phalanx na babban yatsan hannu, bi da bi (Hoto 1). Lokacin da jijiyar ta zazzage, akwai ƙarfin juzu'i mai girma, musamman lokacin da karkatacciyar wuyan hannu ko motsin yatsan hannu, kusurwar ninkaya yana ƙaruwa, yana ƙara juzu'i tsakanin tendon da bangon kwasfa. Bayan dogon lokaci mai maimaitawa na yau da kullun, synovium yana gabatar da canje-canje masu kumburi irin su edema da hyperplasia, yana haifar da kauri, mannewa ko ƙunshewar jijiya da bangon kubu, wanda ke haifar da bayyanar asibiti na stenosis tenosynovitis.
Hoto na 1 Tsarin Halitta na tsarin styloid na radius
II.Clinical ganewar asali
1.A tarihin likita ya fi kowa a tsakiyar shekaru, masu aiki da hannu, kuma ya fi kowa a cikin mata; Farawa yana jinkiri, amma alamun suna iya faruwa ba zato ba tsammani.
2.Signs: ciwo na gida a cikin tsarin styloid na radius, wanda zai iya haskakawa zuwa hannun hannu da ƙafar ƙafa, raunin yatsan yatsa, ƙayyadaddun yatsa mai iyaka, haɓaka bayyanar cututtuka lokacin da babban yatsa da kuma karkatar da wuyan hannu; Nodules mai laushi na iya zama mai ɗanɗano a tsarin sitiloid na radius, kama da fitaccen ƙashi, tare da alamar taushi.
3.Gwajin Finkelstein (watau gwajin karkatar da ƙwayar cuta) yana da inganci (kamar yadda aka nuna a hoto na 2), babban yatsan yatsan hannu yana jujjuya kuma yana riƙe a cikin tafin hannu, wuyan ulnar yana karkata, kuma zafi a tsarin radius styloid yana ƙaruwa.
4.Auxiliary jarrabawa: X-ray ko launi duban dan tayi gwajin za a iya yi idan ya cancanta don tabbatar da ko akwai rashin daidaituwa na kashi ko synovitis. Sharuɗɗa don Maganin Multidisciplinary na Styloid Stenosis Tenosynovitis na Radius Lura cewa ana buƙatar wasu gwaje-gwaje na jiki don bambanta tsakanin osteoarthritis, cututtuka na reshe na sama na jijiyar radial, da ciwon goshin cruciate a lokacin ganewar asali.
III.Magani
Maganin ra'ayin mazan jiya na immobilization na gida: A farkon mataki, marasa lafiya na iya amfani da takalmin gyaran kafa na waje don kawar da gaɓoɓin da abin ya shafa don rage ayyukan gida da kuma kawar da gogayya na jijiyoyi a cikin kumfa na tendon don cimma burin jiyya. Koyaya, rashin motsi bazai iya tabbatar da cewa gaɓar da abin ya shafa ya kasance a wurin ba, kuma tsayin daka na iya haifar da taurin motsi na dogon lokaci. Ko da yake ana amfani da wasu jiyya-taimakawa da ƙarfi a aikin asibiti, ingancin jiyya ya kasance mai kawo rigima.
Maganin occlusion na gida: A matsayin maganin ra'ayin mazan jiya da aka fi so don maganin asibiti, maganin hanawa na gida yana nufin allurar intrathecal a wurin jin zafi na gida don cimma manufar maganin kumburi na gida. Maganin occlusive na iya yin allurar magunguna a cikin wuri mai raɗaɗi, jakar haɗin gwiwa, gangar jikin jijiya da sauran sassa, wanda zai iya rage kumburi da rage zafi da kuma kawar da spasms a cikin ɗan gajeren lokaci, kuma yana taka rawa mafi girma wajen magance cututtuka na gida. Maganin ya ƙunshi yafi triamcinolone acetonide da lidocaine hydrochloride. Hakanan ana iya amfani da allurar hyaluronate sodium. Duk da haka, hormones na iya samun rikitarwa kamar ciwon bayan allura, launin fata na gida, atrophy nama na gida na gida, raunin jijiya na radial, da hawan jini. Babban contraindications shine rashin lafiyar hormone, masu ciki da masu lactating. Sodium hyaluronate na iya zama mafi aminci kuma yana iya hana tabo na mannewa a kusa da tendon kuma yana inganta warkar da tendon. Tasirin asibiti na maganin occlusive a bayyane yake, amma akwai rahotanni na asibiti game da necrosis na yatsa wanda ya haifar da allurar gida mara kyau (Hoto 3).
Fig.3 Sashe na ɓoye yana haifar da necrosis na yatsan yatsan yatsa: A. Fatar hannu ba ta da kyau, kuma B, C. Tsakiyar tsakiya na yatsan yatsa yana da nisa, kuma yatsa necrosis necrosis.
Kariya don maganin occlusive a cikin maganin radius styloid stenosis tenosynovitis: 1) Matsayin daidai ne, kuma dole ne a janye sirinji kafin allurar da miyagun ƙwayoyi don tabbatar da cewa allurar ba ta shiga cikin jini; 2) Gyaran gaɓoɓin da ya dace don gujewa yin aiki da wuri; 3) Bayan allurar occlusion na hormone, sau da yawa ana samun digiri daban-daban na ciwo, kumburi, har ma da ƙara yawan ciwo, gabaɗaya yana ɓacewa a cikin kwanaki 2 ~ 3, idan ciwon yatsa da pallor ya bayyana, maganin antispasmodic da anticoagulant ya kamata a ba da sauri, kuma angiography ya kamata a yi don tabbatar da ganewar asali idan ya yiwu, kuma ya kamata a gudanar da bincike na jijiyoyin jini da wuri-wuri don jinkirin yanayin; 4) Abubuwan da ke haifar da hormone kamar hauhawar jini, ciwon sukari, cututtukan zuciya da sauransu, bai kamata a yi amfani da su tare da rufewar gida ba.
Shockwave: magani ne mai ra'ayin mazan jiya, wanda ba shi da haɗari wanda ke da damar samar da makamashi a waje da jiki da kuma samar da sakamako a cikin yankunan da aka yi niyya a cikin jiki ba tare da lalata ƙwayoyin da ke kewaye ba. Yana da tasirin haɓaka metabolism, ƙarfafa jini da wurare dabam dabam na lymphatic, inganta ingantaccen abinci mai gina jiki, toshewar capillaries, da sassauta haɗin gwiwa mai laushi adhesions. Duk da haka, ya fara a ƙarshen maganin styloid stenosis tenosynovitis na radius, kuma rahotannin bincikensa ba su da yawa, kuma har yanzu ana buƙatar manyan nazarin da bazuwar bazuwar don samar da ƙarin shaidar likita na shaida don inganta amfani da shi a cikin maganin styloid stenosis tenosynovitis cuta na radius.
Maganin acupuncture: ƙananan maganin acupuncture shine hanyar sakin rufaffiyar tsakanin jiyya na tiyata da magani ba na tiyata ba, ta hanyar bushewa da kwasfa na raunuka na gida, an saki adhesions, kuma an sami kwanciyar hankali da tarko na jijiyar jijiyoyin jijiyoyin bugun jini, kuma ana inganta yaduwar jini na kyallen da ke kewaye ta hanyar haɓakar ƙoshin lafiya, rage ƙoshin ƙoshin lafiya. na anti-mai kumburi da analgesic.
Maganin gargajiya na kasar Sin: Radial styloid stenosis tenosynovitis yana cikin nau'in "ciwon inna" a cikin magungunan mahaifar mahaifa, kuma cutar ta dogara ne akan rashi da ma'auni. Saboda aikin dogon lokaci na haɗin gwiwa na wuyan hannu, damuwa mai yawa, wanda ya haifar da qi na gida da rashi na jini, ana kiran wannan rashi na asali; Saboda rashin qi na gida da na jini, tsokoki da jijiyoyi suna ɓacewa a cikin abinci mai gina jiki da zamewa, kuma saboda jin iska, sanyi da damshi, wanda ke tsananta toshewar qi da aikin jini, ana ganin kumburin gida da zafi da aiki yana ƙuntatawa, kuma tarin qi da jini ya fi tsanani kuma spasm na gida ya fi tsanani da wuyar wuyansa. metacarpophalangeal haɗin gwiwa yana ƙaruwa a cikin asibiti, wanda shine ma'auni. An gano a asibiti cewa maganin moxibustion, tausa, jiyya na waje na magungunan gargajiya na kasar Sin da maganin acupuncture suna da wasu tasirin asibiti.
Maganin tiyata: Ƙarƙashin tiyata na ligament na carpal na radius da iyakacin iyaka yana daya daga cikin jiyya na stenosis tenosynovitis a cikin tsarin styloid na radius. Ya dace da marasa lafiya tare da maimaita tenosynovitis na radius styloid stenosis, wanda ba shi da tasiri bayan da yawa na gida da kuma sauran jiyya na mazan jiya, kuma alamun suna da tsanani. Musamman a cikin marasa lafiya tare da ci gaba na tenosynovitis stenotic, yana sauƙaƙa zafi mai tsanani da rashin ƙarfi.
Tiyata ta buɗe kai tsaye: Hanyar fiɗa ta al'ada ita ce yin ɓangarorin kai tsaye a wuri mai taushi, fallasa ƙwayar tsoka ta farko ta dorsal, a yanke kumbun tsoka mai kauri, sannan a saki kumfan tendon ta yadda jijiyar za ta iya zamewa cikin yardar kaina a cikin kullin tendon. Yin tiyata ta buɗe kai tsaye yana da sauri don cimmawa, amma yana ɗaukar jerin haɗarin tiyata kamar kamuwa da cuta, kuma saboda cire rukunin tallafi kai tsaye yayin tiyata, ɓarkewar jijiyoyi da lahani ga jijiyoyi da jijiyoyin radial na iya faruwa.
Septolysis na farko: Wannan hanyar tiyatar ba ta yanke kumbun tsoka mai kauri ba, amma tana kawar da cyst ɗin ganglion da aka samu a cikin septum na 1st ko kuma ya yanke septum tsakanin abductor pollicis longus da extensor pollicis brevis don sakin dorsal extensor septum na 1st. Wannan hanya ta yi kama da aikin tiyatar buɗe ido kai tsaye, babban bambanci shi ne cewa bayan yanke ƙwanƙarar tallafin extensor, sai a saki kubuwar jijiyar a cire ta a maimakon ta hanyar ƙwanƙwasa ƙwan ƙwan tsoka. Ko da yake subluxation na tendon na iya kasancewa a cikin wannan hanya, yana kare 1st dorsal extensor septum kuma yana da tasiri mai tsawo na tsawon lokaci don kwanciyar hankali fiye da ƙaddamar da ƙwayar tsoka. Rashin lahani na wannan hanya ya samo asali ne saboda gaskiyar cewa ba a cire kullin tendon mai kauri ba, kuma kumfa mai kauri na iya zama mai kumburi, edema, da rikici tare da tendon zai haifar da sake dawowa da cutar.
Arthroscopic osteofibrous duct augmentation: arthroscopic magani yana da abũbuwan amfãni daga m rauni, gajere sake zagayowar jiyya, babban aminci, m rikitarwa da kuma sauri dawo da, da kuma babbar amfani shi ne cewa extensor goyon bayan bel ba a incised, kuma ba za a samu a jijiya dislocation. Duk da haka, har yanzu akwai jayayya, kuma wasu malaman sun yi imanin cewa tiyata na arthroscopic yana da tsada kuma yana cin lokaci, kuma amfanin da yake da shi a kan aikin tiyata kai tsaye ba a bayyana ba. Don haka, yawancin likitoci da marasa lafiya ba su zaɓi maganin arthroscopic gabaɗaya.
Lokacin aikawa: Oktoba-29-2024
