摘要
目的对比自制式“镰刀状”小针刀微创治疗与开放手术治疗手指屈肌腱狭窄性腱鞘炎的疗效。方法选择我院2005年1月—2011年12月收治的手指屈肌腱狭窄性腱鞘炎患者268例（306指），Quinnell分级均为Ⅲ一Ⅳ级，根据患者意愿分为针刀组153例（175指）和手术组115例（131指）。针刀组行自制式“镰刀状”小针刀微创治疗，对滑车A1部进行切割松解；手术纽行开放手术治疗，对滑车A1部进行切除。结果针刀组手术时间为（2．0．4-0．5）rain。手术组为（15．0±3．0）min，针刀组手术时间少于手术组（t=52．667，P=0．000）。针刀组术后3h毛细血管充盈试验皮肤由白转红平均时间为（1．5±0．3）s，手术组为（1．5-i-0．2）s，两组间差异无统计学意义（t=0．000，P=1．000）。两组患者术后术指感觉均正常。268例患者（306指）均获随访，随访时间为1．0—3．5年，平均1．5年。两组患者均未出现切口红肿、渗液等并发症。针刀组术后1周有4例患者（4指）屈伸活动时仍存在扳机样感及顿挫感，经小针刀再次治疗后痊愈，3例患者（3指）症状无明显改善，行开放手术后治愈；手术组患者术指屈伸活动均正常。针刀组疗效评定优125例（150指）、良21例（18指）、差7例（7指）；手术组优98例（113指）、良17例（18指）、差0例，两组疗效间差异无统计学意义（u=5．515，P=0．063）。结论自制式“镰刀状”小针刀微创治疗手指屈肌腱狭窄性腱鞘炎具有创伤小、见效快、操作简单等优点，值得临床推广应用。
Objective To compare the clinical effect of minimally invasive surgery by self - made sickle shaped small needle knife and open surgery in the treatment of finger flexor tendon stenosing tenosynovitis （FFTST） . Methods 268 FFTST patients （306 fingers） admitted to our hospital from January 2005 to December 2011 were involved into the study and they were all classified as III to IV according to Quinnell classification standard. According to patients＇ will, they were divided into needle knife group （153 cases, 175 fingers） and open surgery group （115 cases, 131 fingers） . The needle knife group was treated with self - made sickle shaped small needle knife, and trochlea A1 was cut to make it loose. The open surgery group was treated with open surgery, and trochlea A1 was removed. Results The operation time of needle knife group was （2.0 ± 0. 5） min, significantly shorter than the open surgery group＇s [ （ 15.0 ± 3.0） min, t = 52. 667, P = 0. 000 ] . The capillary refill time of the needle knife group 3 h after surgery was （ 1.5 ± 0. 3 ） s, showing no statistically significant difference compared with the open surgery group＇s [ （ 1.5 ±0.2） s, t =0. 000, P = 1. 000] . Both groups had normal feelings in the treated fingers. All the 268 patients （306 fingers） were followed up for 1.0 to 3.5 years, with an average of 1.5 years. No patient from the two groups showed swollen incision or seepage. In the needle knife group, four cases （4 fingers） had trigger - like feeling and unsmooth movement, and they were cured after another round of needle knife surgery. Three cases showed no significant improvement in symptoms before they were cured by open surgery. All patients from the open surgery group had smooth movement of fingers. The clinical effect assessment： needle knife group： exceUent （125 cases, 150 fingers）, good （21 cases, 18 fingers）, bad （7 cases, 7 fingers） . Open surgery group： excellent （98 cases, 113 fingers）, good （17 cases, 18 fingers）, bad （no one）. The clinical effect between the two groups showed no statistically significant difference （ u = 5.515, P = 0. 063 ） . Conclusion The self- made sickle shaped small needle knife has advantages like minimal invasion, high curing rate and simple operation, and should be promoted in clinic.
出处
《中国全科医学》
CAS
CSCD
北大核心
2013年第30期3611-3613,共3页
Chinese General Practice
关键词
小针刀
腱鞘炎
腱嵌压
治疗结果
Small acupotomology
Tenosynovitis
Tendon entrapment
Treatment outcome
