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To observe the flexor tendon sheath of flexor tendon sheath was injected with a small knife inside the injection plus tenosynovitis of flexor tendon therapy clinical therapy. Methods 83 patients with flexor tendon tenosynovitis clinic patients were randomly divided into two groups, A groups: control group 41 cases, the use of tendon sheath injection therapy. B group: 42 patients observed within the tendon sheath injection plus with a small knife therapy. The results A, B Observation of two groups: 15 patients were cured (36.59%) and 35 (83.33% ), effective for the 32 cases, respectively (78.05%) and 41 cases (97.62%), cure rate and efficiency of B group was significantly higher than that of A group (P <0.05); ineffective were 9 cases (21.95%) and 1 cases (2.38%), recurrence rates of 14 patients (34.15%) and 2 cases (4.76%), relapse rate and inefficiency of group B was significantly lower than A (P <0.05). Conclusion injection plus small knife sheath Treatment of tendon sheath injection therapy than clinical grading of more than grade ?? tenosynovitis of flexor tendon high efficacy, and less recurrence.
[Keywords:] tenosynovitis; tendon sheath injection; small knife
Finger flexor tendon tenosynovitis (Tenosynovitis of hand fLexor tendons), also known as "trigger finger" or "snapping means," to the metacarpophalangeal joints pain and snapping the main symptoms. The disease can occur at different ages, more common in housewives and manual workers. Any finger may occur, but more common in the thumb, middle finger and ring finger, is the impact of common clinical pain in the fingers of disease activity. tendon sheath injection usually non-surgical treatment, non-surgical treatment failure if surgery is required to narrow fibrous tendon sheath tendon sheath incision line partial resection of cartilage rings. I subjects with tendon sheath injection needle-knife therapy plus high efficacy tenosynovitis of flexor tendon, and less recurrence, are as follows.
1 Clinical data
1.1 General information on this group were selected from October 2004 to December 2006 during treatment for the disease and the degree of clinical grade ?? [1] (metacarpal bone risk refers to the local pain, tenderness and mild swelling, tenderness palpable induration, friction sensitivity occurs, occasionally snapping) or more of the 83 patients. male 23, female 56 cases, aged 18 to 83 years, mean 50 years of age, duration of two weeks to 3 years, an average of 5 months. which means a single thumb incidence of 71 cases, mean incidence of 2 cases of a single index finger, ring finger means the incidence of 1 case of single, double thumb while incidence of 9 cases. The patients were randomly divided into two groups, A groups: control group 41 cases, the use of tendon sheath injection therapy. B Group: Observation 42 patients with tendon sheath injection plus small knife therapy. two groups in gender, age, disease duration, disease severity (clinical classification) terms were no significant differences.
degree of clinical classification: risk refers to the palm of local bone pain, tenderness and mild swelling.
degree: In addition to grade
symptoms, tender points can be touched sclerosis, friction sensitivity occurs, occasionally snapping.
degree: frequent snapping , occasionally interlocking symptoms.
degree: frequent symptoms of locking.
1.2 after treatment in patients with burglary, natural stretch palm up fingers, flat on the treatment table. Routine disinfection shop towels, to risk his hand palm side of the hard nodules at the bone for the needle position, the anti-inflammatory analgesic solution (dexamethasone palmitate 4mg + Vitamin B650mg + Vitamin B120.5mg +2% lidocaine 3mL dubbed 6mL) 2mL into the tendon sheath, the injection means the patient feels pain and to suffer from finger radiation, while distal pulp swelling, skin gray, proved drugs are injected into flexor tendon sheath. posted at the injection site after injection of benzalkonium chloride paste. 1 week, 1 to 2 times as a course of treatment, risk refers to the brake as much as possible, rest for 1 week.
Add a small knife inside the tendon sheath injection therapy such as injection of the tendon sheath tendon sheath injection therapy first, the last remaining anti-inflammatory analgesic solution 0.5mL side back side of injection needles, to the subcutaneous finished. Be patient injection site pain was gone, with 4 small the skin at the injection point of the vertical knife needle, knife-edge parallel to the vertical line and the cut strip of flexor tendon, lateral goes, if it should be cut release sclerosis, back knife to skin, instruct patient suffering from active flexion and extension means. If still a snapping and locking, repeat the above operation until the risk refers to the flexion and extension freely, without snapping and locking. refers to excessive dorsiflexion risk of surgery to stop bleeding, knife mouth in the benzalkonium chloride paste. instruct patient on the tiger's mouth to stop bleeding 5min, the next day began to suffer from that often do flexion and extension exercises. 1 week, 1 to 2 times as a course of treatment.
1.3 to assess the clinical efficacy is divided into three:
cure: risk refers to the pain, tenderness disappeared, so easily, without snapping and locking;
improvement: risk refers to the pain, tenderness, reduced activity was normal fingers, snapping and locking minor ;
invalid: risk refers to the pain, tenderness, snapping and locking as before or increased.
1.4 Statistical Methods The statistical software SPSS 11.5 for statistical analysis, line ??2 test, P <0.05 was considered statistically significant.
All patients were in the treatment of a course of 2 weeks after the statistical treatment, followed up for six months. In the follow-up period, the cured or improved in symptoms and functional levels back to pre-treatment than before treatment, or no obvious improvement in symptoms and function for the recurrence; collectively referred to as an effective cure and improvement. A, B Observation of clinical treatment groups shown in Table 1. which is not found to be infected B group of cases, complications such as bowstring sign. Table 1 Comparative clinical efficacy
3 Discussion
Tenosynovitis of finger flexor tendon in the metacarpal bone disease sites corresponding to the song refers to the beginning of the tendon sheath fiber department. Here by a thick fibrous sheath with the ring metacarpal bone fibrous form a relatively narrow tube. Refers to the song through this tendon by mechanical stimulation at leaving when the friction increase, coupled with the uplift of parts of the palm bones, hands holding things, the tendon sheath by a hard object with the palm squeeze both bone damage, and gradually form a narrow ring [2]. pathogenesis of early as the flexor tube through the fibrous tendon strain arising from the friction of aseptic inflammation, congestion and edema.
in possession of advanced fibrous thickening gradually harden to form a narrow ring, flexor tendon is also deformed, or gourd-shaped spindle-shaped swelling, causing the tendon through the difficulties, suffering from disorders that range of motion, pain, snapping and locking symptoms. early patient sheath corticosteroid injection drugs, can reduce local inflammation and edema, to prevent progression to reach the purpose of healing. But in the late within the tendon sheath in patients with simple injections of glucocorticoid anti-inflammatory drugs can reduce swelling, relieve symptoms and can not lift the flexor tendon sheath stenosis and enlargement of the root causes of proliferation, poor efficacy, not multiple injections, further treatment will need surgery. conventional surgery treatment is to narrow sheath incision, partial resection of fibrous tubes [3], but the trauma and postoperative prone to tendon adhesions, affecting long-term effect.
and add a small knife sheath injection therapy to avoid the shortcomings of both , in line with minimally invasive, high efficacy of the principle of a small knife can be narrow and deformation of the swollen tendon sheath longitudinal incision decompression, lysis of adhesions, reduction of the tendon sheath on the oppression and friction, in order to address its root causes Therefore, the higher efficacy. Therefore, the cure rate and efficiency of B group was significantly higher than that of A group (P <0.05), which is consistent with the conclusions of other scholars. [4] note the following treatment to improve efficacy and reduce complications:
tendon sheath injection treatment, the drugs should be accurately injected into the tendon sheath;
small knife cut the release of tendon sheath should be appropriate to snapping and locking symptoms disappear prevail, to avoid bad effect or cause symptoms bowstring;
times after treatment risk refers to the functional exercise date.
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