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[1]朱國文,姚新苗,呂一,等.彎形針刀經(jīng)皮松解術(shù)治療屈指肌腱狹窄性腱鞘炎的臨床研究[J].中醫(yī)正骨,2014,26(01):31-37.
 Zhu Guowen*,Yao Xinmiao,Lyu Yi,et al.Clinical study on percutaneous release with curved knife needle in the treatment of stenosing tenovaginitis of finger flexor tendon[J].The Journal of Traditional Chinese Orthopedics and Traumatology,2014,26(01):31-37.
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彎形針刀經(jīng)皮松解術(shù)治療屈指肌腱狹窄性腱鞘炎的臨床研究()
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《中醫(yī)正骨》[ISSN:1001-6015/CN:41-1162/R]

卷:
第26卷
期數(shù):
2014年01期
頁碼:
31-37
欄目:
臨床研究
出版日期:
2014-01-28

文章信息/Info

Title:
Clinical study on percutaneous release with curved knife needle in the treatment of stenosing tenovaginitis of finger flexor tendon
作者:
朱國文1姚新苗2呂一2傅建明3
1.浙江省杭州市蕭山區(qū)中醫(yī)骨傷科醫(yī)院,浙江 杭州 311261;
2.浙江中醫(yī)藥大學(xué)附屬第三醫(yī)院,浙江 杭州 310005;
3.浙江省嘉興市第二醫(yī)院,浙江 嘉興 314000
Author(s):
Zhu Guowen*Yao XinmiaoLyu Yi Fu Jianming.
*Xiaoshan TCM Orthopedic-Traumatological Hospital,Hangzhou 311261,Zhejiang,China
關(guān)鍵詞:
扳機指癥 封閉療法 小刀針
Keywords:
Trigger finger disorder Blocking therapy Small knife needle
摘要:
目的:研究彎形針刀經(jīng)皮松解術(shù)治療Ⅱ°、Ⅲ°屈指肌腱狹窄性腱鞘炎的臨床療效。方法:將117例Ⅱ°、Ⅲ°屈指肌腱狹窄性腱鞘炎患者隨機分為3組,治療組40例44指,采用彎形針刀經(jīng)皮松解術(shù)治療; 對照A組38例42指,采用直形針刀經(jīng)皮松解術(shù)治療; 對照B組39例43指,采用腱鞘內(nèi)局部封閉治療。分別于治療前、治療后即刻和治療后3個月,記錄并比較3組患者患指疼痛評分以及患指彈響消失、屈伸活動度改善、葫蘆狀結(jié)節(jié)消失情況。并于治療后3個月評價3組患者的總體療效及1次治愈率。結(jié)果:①患指疼痛視覺模擬評分。不同時間點間患指疼痛視覺模擬評分的差異有統(tǒng)計學(xué)意義(F=596.26,P=0.000)。3組患者患指疼痛視覺模擬評分的組間差異總體上有統(tǒng)計學(xué)意義(F=8.040,P=0.000)。進一步比較顯示,治療前及治療后即刻3組患指疼痛視覺模擬評分比較,組間差異均無統(tǒng)計學(xué)意義[(6.60±1.50)分,(7.20±1.50)分,(7.20±1.30)分,F=2.613,P=0.077;(1.20±0.60)分,(1.70±1.00)分,(2.30±1.20)分,F=1.569,P=0.212)]; 治療后3個月3組患指疼痛視覺模擬評分比較,組間差異有統(tǒng)計學(xué)意義[(0.94±0.60)分,(2.08±0.99)分,(3.23±1.43)分,F=50.460,P=0.000]; 進一步兩兩比較,治療組患指疼痛視覺模擬評分低于對照A組和對照B組(P=0.000,P=0.000),對照A組患指疼痛視覺模擬評分低于對照B組(P=0.000)。時間因素與分組因素存在交互效應(yīng)(F=51.540,P=0.000)。②患指體征。治療后即刻及治療后3個月,治療組患指彈響消失數(shù)(37指,43指)多于對照A組(20指,32指)和對照B組(9指,11指),差異有統(tǒng)計學(xué)意義(Z=4.690,P=0.000; Z=7.390,P=0.000); 并且隨著治療后時間的增加,患肢彈響消失數(shù)增加(Z=-10.290,P=0.000)。治療后即刻及治療后3個月,治療組患指屈伸活動度改善數(shù)(35指,43指)多于對照A組(18指,32指)和對照B組(8指,11指),差異有統(tǒng)計學(xué)意義(Z=4.720,P=0.000; Z=7.010,P=0.000); 并且隨著治療后時間的增加,患指屈伸活動度改善數(shù)增加(Z=-10.300,P=0.000)。治療后即刻及治療后3個月,治療組患指葫蘆狀結(jié)節(jié)消失數(shù)(30指,40指)多于對照A組(15指,25指)和對照B組(0指,9指),差異有統(tǒng)計學(xué)意義(Z=4.150,P=0.000; Z=9.040,P=0.000); 并且隨著治療后時間的增加,患指葫蘆狀結(jié)節(jié)消失數(shù)增加(Z=-10.980,P=0.000)。③總體療效。治療組痊愈42指,顯效1指,有效1指; 對照A組痊愈32指,顯效6指,有效3指,無效1指; 對照B組痊愈11指,顯效9指,有效8指,無效15指。治療組的總體療效優(yōu)于對照A組和對照B組,差異有統(tǒng)計學(xué)意義(R^-治療組=0.068,R^-對照A組=0.357,R^-對照B組=1.627; χ2=693.325,P=0.000)。④1次治愈率。治療組1次治愈37指,1次未治愈7例; 對照A組1次治愈18指,1次未治愈24例; 對照B組1次治愈5指,1次未治率38例。3組患者的1次治愈率比較,差異有統(tǒng)計學(xué)意義(χ2=46.234,P=0.000)。進一步兩兩比較(調(diào)整檢驗水準:α'=0.017),治療組的1次治愈率高于對照A組和對照B組(χ2=15.848,P=0.000; χ2=45.731,P=0.000); 對照A組的1次治愈率高于對照B組(χ2=10.499,P=0.001)。結(jié)論:采用彎形針刀經(jīng)皮松解術(shù)治療屈指肌腱狹窄性腱鞘炎,能夠明顯緩解患指疼痛,改善患指功能,創(chuàng)傷小,操作簡單,療效確切,1次治愈率高,可以作為治療Ⅱ°、Ⅲ°屈指肌腱狹窄性腱鞘炎的首選方法,值得臨床推廣應(yīng)用。
Abstract:
Clinical study on percutaneous release with curved knife needle in the treatment of stenosing tenovaginitis of finger flexor tendon Zhu Guowen*,Yao Xinmiao,Lyu Yi, Fu Jianming.*Xiaoshan TCM Orthopedic-Traumatological Hospital,Hangzhou 311261,Zhejiang,China ABSTRACT Objective:To study the clinical effect of percutaneous release with curved knife needle on gradeⅡandⅢstenosing tenovaginitis of finger flexor tendon.Methods:One hundred and seventeen patients with gradeⅡandⅢstenosing tenovaginitis of finger flexor tendon were randomly divided into 3 groups,40 patients(treatment group)were treated with percutaneous release with curved knife needle in 44fingers,38 patients(control group A)were treated with percutaneous release with straight knife needle in 42 fingers,and 39 patients(control group B)were treated with intra-tendovaginal injection in 43 fingers.The pain scores,clickings elimination,improvement of flexion-extension range and disappearance of the gourd-shaped nodules of the fingers were recorded and compared between the 3 groups before the treatment,immediately after the treatment and 3 months after the end of treatment respectively.The overall curative effects and one-time cure rate were evaluated and compared between the 3 groups 3 months after the end of treatment.Results:There were statistical difference in the finger pain visual analogue scale(VAS)scores between different time points(F=596.26,P=0.000).In general,there were statistical difference in the finger pain VAS scores between the 3 groups(F=8.040,P=0.000).Further comparison indicated that there were no statistical difference in the finger pain VAS scores between the 3 groups before the treatment and immediately after the treatment(6.60+/-1.50,7.20+/-1.50,7.20+/-1.30 points,F=2.613,P=0.077; 1.20+/-0.60,1.70+/-1.00,2.30+/-1.20 points,F=1.569,P=0.212).There were statistical difference in the finger pain VAS scores between the 3 groups 3 months after the end of treatment(0.94+/-0.60,2.08+/-0.99,3.23+/-1.43 points,F=50.460,P=0.000).Further comparison showed that the finger pain VAS scores of treatment group were less than that of control group A and control group B(P=0.000,P=0.000),and the finger pain VAS scores of control group A were less than that of control group B(P=0.000).There was interaction between time factor and group factor(F=51.540,P=0.000).More fingers with clickings elimination were found in the treatment group(37 and 43 fingers)compared to control group A(20 and 32 fingers)and control group B(9 and 11 fingers)immediately after the treatment and 3 months after the end of treatment,and there were statistical difference between the treatment group and other two groups(Z=4.690,P=0.000; Z=7.390,P=0.000).The number of fingers with clickings elimination increased as time went on after the treatment(Z=-10.290,P=0.000).More fingers with improved flexion-extension range were found in the treatment group(35 and 43 fingers)compared to control group A(18 and 32 fingers)and control group B(8 and 11 fingers)immediately after the treatment and 3 months after the end of treatment,and there were statistical difference between the treatment group and other two groups(Z=4.720,P=0.000; Z=7.010,P=0.000).The number of fingers with improved flexion-extension range increased as time went on after the treatment(Z=-10.300,P=0.000).More fingers with disappearance of the gourd-shaped nodules were found in the treatment group(30 and 40 fingers)compared to control group A(15 and 25 fingers)and control group B(0 and 9 fingers)immediately after the treatment and 3 months after the end of treatment,and there were statistical difference between the treatment group and other two groups(Z=4.150,P=0.000; Z=9.040,P=0.000).The number of fingers with disappearance of gourd-shaped nodules increased as time went on after the treatment(Z=-10.980,P=0.000).The result of total curative effect showed that 42 fingers obtained an excellent result,1 good and 1 fair in the treatment group; while 32 fingers obtained an excellent result,6 good,3 fair and 1 poor in the control group A; and 11 fingers obtained an excellent result,9 good,8 fair and 15 poor in the control group B.The treatment group surpassed the control group A and control group B in the total curative effect(R^-treatment group=0.068,R^-control group A=0.357,R^-control group B=1.627; χ2=693.325,P=0.000).The result of one time cure rate showed that 37 fingers got primary cure and 7 fingers did not get primary cure in the treatment group; while 18 fingers got primary cure and 24 did not get primary cure in the control group A,and 5 fingers got primary cure and 38 did not get primary cure in the control group B.There were statistical differences in one time cure rate between the 3 groups(χ2=46.234,P=0.000).Further pairwise comparison(α'=0.017)showed that the one time cure rate of treatment group was higher than that of control group A and control group B(χ2=15.848,P=0.000; χ2=45.731,P=0.000),and the one time cure rate of control group A was higher than that of control group B(χ2=10.499,P=0.001).Conclusion:In the treatment of stenosing tenovaginitis of finger flexor tendon,the method of percutaneous release with curved knife needle can relief the finger pain obviously and improve the finger performance with less trauma,simple operation,definite curative effect and high one time cure rate,so it can be chosen as the chief method for gradeⅡandⅢstenosing tenovaginitis of finger flexor tendon,and it is worth popularizing in clinic.

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備注/Memo

備注/Memo:
基金項目:浙江省中醫(yī)藥科技計劃項目(2007SA003)
更新日期/Last Update: 2014-01-20