[1]朱国文,姚新苗,吕一,等.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[J].中医正骨,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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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()
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《中医正骨》[ISSN:1001-6015/CN:41-1162/R]

卷:
第26卷
期数:
2014年01期
页码:
31-37
栏目:
临床研究
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:
朱国文1; 姚新苗2; 吕一2; 傅建明3
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
Author(s):
Zhu Guowen*; Yao Xinmiao; Lyu Yi;  Fu Jianming.
*Xiaoshan TCM Orthopedic-Traumatological Hospital,Hangzhou 311261,Zhejiang,China
关键词:
扳机指症 封闭疗法 小刀针
Keywords:
Trigger finger disorder;  Blocking therapy;  Small knife needle
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,患指屈伸活动度改善数增加(Z=-10.300,P=0.000)。治疗后即刻及治疗后3个月,治疗组患指葫芦状结节消失数(30指,40指)多于对照A组(15指,25指)和对照B组(0指,9指),差异有统计学意义(Z=4.150,P=0.000; Z=9.040,P=0.000); 并且随着治疗后时间的增加,患指葫芦状结节消失数增加(Z=-10.980,P=0.000)。③总体疗效。治疗组痊愈42指,显效1指,有效1指; 对照A组痊愈32指,显效6指,有效3指,无效1指; 对照B组痊愈11指,显效9指,有效8指,无效15指。治疗组的总体疗效优于对照A组和对照B组,差异有统计学意义(R^-治疗组=0.068,R^-对照A组=0.357,R^-对照B组=1.627; χ2=693.325,P=0.000)。④1次治愈率。治疗组1次治愈37指,1次未治愈7例; 对照A组1次治愈18指,1次未治愈24例; 对照B组1次治愈5指,1次未治率38例。3组患者的1次治愈率比较,差异有统计学意义(χ2=46.234,P=0.000)。进一步两两比较(调整检验水准:α'=0.017),治疗组的1次治愈率高于对照A组和对照B组(χ2=15.848,P=0.000; χ2=45.731,P=0.000); 对照A组的1次治愈率高于对照B组(χ2=10.499,P=0.001)。结论:采用弯形针刀经皮松解术治疗屈指肌腱狭窄性腱鞘炎,能够明显缓解患指疼痛,改善患指功能,创伤小,操作简单,疗效确切,1次治愈率高,可以作为治疗Ⅱ°、Ⅲ°屈指肌腱狭窄性腱鞘炎的首选方法,值得临床推广应用。
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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备注/Memo

备注/Memo:
基金项目:浙江省中医药科技计划项目(2007SA003)
更新日期/Last Update: 2014-01-20