弯形针刀经皮松解术治疗屈指肌腱狭窄性腱鞘炎的临床研究  

Clinical study on percutaneous release with curved knife needle in the treatment of stenosing tenovaginitis of finger flexor tendon

作　　者：朱国文 姚新苗[2] 吕一[2] 傅建明[3] 

机构地区：[1]浙江省杭州市萧山区中医骨伤科医院,浙江杭州311261 [2]浙江中医药大学附属第三医院,浙江杭州310005 [3]浙江省嘉兴市第二医院,浙江嘉兴314000

出　　处：《中医正骨》2014年第1期31-37,共7页The Journal of Traditional Chinese Orthopedics and Traumatology

基　　金：浙江省中医药科技计划项目(2007SA003)

摘　　要：目的:研究弯形针刀经皮松解术治疗Ⅱ°、Ⅲ°屈指肌腱狭窄性腱鞘炎的临床疗效。方法:将117例Ⅱ°、Ⅲ°屈指肌腱狭窄性腱鞘炎患者随机分为3组,治疗组40例44指,采用弯形针刀经皮松解术治疗;对照A组38例42指,采用直形针刀经皮松解术治疗;对照B组39例43指,采用腱鞘内局部封闭治疗。分别于治疗前、治疗后即刻和治疗后3个月,记录并比较3组患者患指疼痛评分以及患指弹响消失、屈伸活动度改善、葫芦状结节消失情况。并于治疗后3个月评价3组患者的总体疗效及1次治愈率。结果:①患指疼痛视觉模拟评分。不同时间点间患指疼痛视觉模拟评分的差异有统计学意义(F=596.26,P=0.000)。3组患者患指疼痛视觉模拟评分的组间差异总体上有统计学意义(F=8.040,P=0.000)。进一步比较显示,治疗前及治疗后即刻3组患指疼痛视觉模拟评分比较,组间差异均无统计学意义[(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)];治疗后3个月3组患指疼痛视觉模拟评分比较,组间差异有统计学意义[(0.94±0.60)分,(2.08±0.99)分,(3.23±1.43)分,F=50.460,P=0.000];进一步两两比较,治疗组患指疼痛视觉模拟评分低于对照A组和对照B组(P=0.000,P=0.000),对照A组患指疼痛视觉模拟评分低于对照B组(P=0.000)。时间因素与分组因素存在交互效应(F=51.540,P=0.000)。②患指体征。治疗后即刻及治疗后3个月,治疗组患指弹响消失数(37指,43指)多于对照A组(20指,32指)和对照B组(9指,11指),差异有统计学意义(Z=4.690,P=0.000;Z=7.390,P=0.000);并且随着治疗后时间的增加,患肢弹响消失数增加(Z=-10.290,P=0.000)。治疗后即刻及治疗后3个月,治疗组患指屈伸活动度改善数(35指,43指)多于对照A组(18指,32指)和对照B组(8指,11指),差异有统计学意义(Z=4.720,P=0.000;Z=7.010,P=0.000);并且随着治疗后时间的增加,患指Objective：To study the clinical effect of percutaneous release with curved knife needle on grade Ⅱ and Ⅲ stenosing tenovagi- nitis of finger flexor tendon. Methods： One hundred and seventeen patients with grade Ⅲ and stenosing 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 44 fingers ,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 4/- 1.50,7.20 4/- 1.30 points, F = 2. 613, P = 0. 077 ; 1.20 4/- 0.60, 1.70 4/- 1.00,2.30 4/- 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 4/- 0.60,2.08 ＋/- 0.99,3.23 4/- 1.43 points, F = 50. 460, P = 0.000）. Further comparison showed that the finger pain VAS scores of treat- ment group were less than that of control group A and control group B�

关 键 词：扳机指症 封闭疗法 小刀针 

分 类 号：R686[医药卫生—骨科学]