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中华关节外科杂志(电子版) ›› 2024, Vol. 18 ›› Issue (02) : 160 -166. doi: 10.3877/cma.j.issn.1674-134X.2024.02.002

临床论著

可视化超声引导下针刀治疗狭窄性腱鞘炎的疗效分析
刘昌盛1, 江思2, 童娟1,†()   
  1. 1. 510120　广州医科大学附属第一医院中医科
    2. 510120　广州医科大学附属第一医院超声科
  • 收稿日期:2023-11-02 出版日期:2024-04-01
  • 通信作者: 童娟
  • 基金资助:
    广州市中医药特色诊疗技术项目(穗卫函[2022]2249号)

Curative effect analysis of pinknife guided by visual ultrasound in treatment of stenotenosynovitis

Changsheng Liu1, Si Jiang2, Juan Tong1,†()   

  1. 1. Chinese Medicine Department of The First Affiliated Hospital of Guangzhou Medical University, Guangzhou 510120, China
    2. Ultrasound Department of The First Affiliated Hospital of Guangzhou Medical University, Guangzhou 510120, China
  • Received:2023-11-02 Published:2024-04-01
  • Corresponding author: Juan Tong
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引用本文：

刘昌盛, 江思, 童娟. 可视化超声引导下针刀治疗狭窄性腱鞘炎的疗效分析[J]. 中华关节外科杂志(电子版), 2024, 18(02): 160-166.

Changsheng Liu, Si Jiang, Juan Tong. Curative effect analysis of pinknife guided by visual ultrasound in treatment of stenotenosynovitis[J]. Chinese Journal of Joint Surgery(Electronic Edition), 2024, 18(02): 160-166.

目的

分析可视化超声引导下小针刀松解术治疗狭窄性腱鞘炎的临床效果。

方法

选取2020年5月至2023年7月广州医科大学附属第一医院针灸门诊就诊狭窄性腱鞘炎患者43例，纳入有手部慢性劳损病史，手指屈伸不利且局限性酸痛，超声显像下腱鞘膜与肌腱之间有病理性改变狭窄性腱鞘炎患者，排除合并严重的基础疾病，如高血压、糖尿病、冠心病者及严重心、肝、肾等器官功能不全，有出血倾向病史，既往曾行开放手术，麻醉药物过敏者。比较超声引导小针刀松解术患者治疗前、治疗后两周及治疗3个月后在疼痛分级指数、视觉模拟评定、疼痛强度评定、关节活动度和治疗满意度指数的变化，观察治疗前后腱鞘厚度变化并与健康组比较，观察超声定点与疼痛点的吻合程度及患处治疗前后比较超声显像变化情况。治疗前后疼痛指数及腱鞘厚度比较采用t检验，关节活动受限程度及满意度采用卡方检验。

结果

研究发现患者对前期治疗效果不满意后选择针刀治疗，简易McGill疼痛问卷评分结果显示治疗后2周与治疗前比较差异有统计学意义(t ＝9.700、13.824，Z＝－6.698，均为P<0.05)，患者对疼痛强度耐受程度、疼痛性质及对疼痛害怕程度较治疗前改善明显；关节活动障碍方面治疗后两周其正常比例达到60.4%，治疗后3个月其正常比例达到100%；治疗满意度方面，治疗两周后满意度为62.8%，治疗3个月后达到100%；治疗前病灶超声影像压痛点与超声下病变阳性影像标记点相吻合，病变部位超声影像出现回声减低情况、血流丰富信号情况，治疗前腱鞘厚度与健康组比较差异有统计学意义(t＝11.473，P<0.05)，治疗3个月后病变部位的压痛点消失，局部回声减低区消失、血流丰富信号情况减少，腱鞘厚度与治疗前比较减小(t＝1.742，P<0.05)，与健康组比较处于相近水平(t＝1.742，P>0.05)，提示腱鞘在治疗后随着循环好转，肌腱周围软组织环境改善。

结论

超声引导能直观反映肌腱及腱鞘内层级变化，显示肌腱及腱鞘粘连精准影像，为针刀操作提供清晰明确的施术视野，提高针刀治疗狭窄性腱鞘炎临床效果，为临床精准治疗狭窄性腱鞘炎提供新的治疗方案。

关键词: 超声成像，介入, 铍针, 腱鞘炎, 腱嵌压, 治疗结果
Objective

To observe the clinical effect of pinknife release guided by visual ultrasound in the treatment of stenotenosynovitis.

Methods

A total of 43 patients with stenotenosynovitis were selected from the acupuncture clinic of the First Affiliated Hospital of Guangzhou Medical University from May 2020 to July 2023. The patients with history of chronic strain of the hand, poor flexion and extension of the fingers and localized soreness were included. The patients with stenotenosynovitis combiningpathological changes between the tenosynovitis membrane and the tendon under ultrasound imaging, and severe underlying diseases (i.e. hypertension, diabetes, coronary disease and severecardial, hepatic, renal dysfunctions, history ofhemorrahge tendency, open surgery, and allergic to anesthesia drugs) were excluded.The changes of pain grading index, visual analogue scale, pain intensity evaluation, joint range of motion and treatment satisfaction of the patients undergoing ultrasound-guided pinknife release were compared before treatment, two weeks and three months after treatment. The changes of tendon sheath thickness before and after treatment were observed and compared with the healthy group. The anastomosis between ultrasonic fixed point and pain point was observed and the changes of ultrasonic imagingbefore and after treatment were compared.T test was used to compare pain indices and tendon sheath thickness before and after treatment, chi square test was used to compare the degree of joint mobility limitation and satisfaction.

Results

The study found that patients chose acupotomy after they were not satisfied with the effect of the previous treatment. The score of McGill pain questionnaire showed that there was statistical significance after two weeks of treatment compared with before treatment (t =9.700, 13.824, Z=-6.698, all P<0.05). Patients′ tolerance to pain intensity, nature of pain and fear of pain were significantly improved compared with before treatment. The normal rate of joint mobility disorders reached 60.4% two weeks after treatment and 100% three months after treatment. Patient satisfaction was 62.8% after two weeks and 100% after three months. Before treatment, the tender point of the lesion was consistent with the positive image marks of the lesion under ultrasound. The ultrasonic image of the lesion showed decreased echo and abundant blood flow signal, and the thickness of tendon sheath before treatment was statistically different from that of the healthy group (t=11.473, P<0.05). Three months after treatment, the tender point of the lesion disappeared. The local hypoechoic area disappeared, the signal of rich blood flow decreased, and the thickness of tendon sheath decreased compared with that before treatment (t=1.742, P<0.05), and was similar to that of healthy group (t=1.742, P>0.05), suggesting that the tendon sheath improved with the improvement of circulation after treatment, and the soft tissue environment around the tendon improved.

Conclusions

Ultrasound guided pinknife therapy can directly reflect the changes of tendon and tendon sheath in the internal level, display the precise image of tendon and tendon sheath adhesion, and provide a clear vision for pinknife operation. It can improve the clinical effect of acupotomy in the treatment of stenotendinitis, and provide a new treatment options for the clinical precision treatment of stenotenosynovitis.

Key words: Ultrasonography, interventional, Pinknife, Tenosynovitis, Tendon entrapment, Treatment outcome
图1 正常手指肌腱、狭窄性腱鞘炎的超声显像，治疗前后的超声显像。图A屈指肌腱炎纵切面包裹性粘连病灶并有液性暗区影像；图B为屈指肌腱炎纵切面肌腱多点粘连、回声减低病灶影像；图C为针刀纵切面疏通低回声区及松解鞘膜粘连影像；图D为屈指肌腱炎肌腱横切面粘连病灶影像；图E为横切面针刀松解鞘膜与肌腱粘连影像；图F为横切面显示针刀松解后肌腱与腱鞘间形成分隔超声影像；图G为健康指肌腱纵切面影像肌腱伸缩顺利无粘连；图H为健康指肌腱横切面肌腱与鞘膜间隙清晰影像；图I为治疗3个月后肌腱的纵切面及腱鞘厚度减小粘连消失影像
Figure 1 Ultrasound imaging of normal finger tendon, stenosis tenosynovitis, before and after treatment.A is the longitudinal section of flexor tendinitis contained adhesive lesions with liquid dark areas; B is reduced echo image of lesion, showing multi-point adhesion of tendon in longitudinal section of flexor finger tendinitis; C is longitudinal section ofpinknife dredging the low echo area and releasing the adhesions of the sheath; D is image of adhesion lesions on the transverse section of tendon in flexor tendinitis; E is image of the adhesion between the sheath and the tendon on the transverse section；F is transverse section image showing the formation of separate ultrasound images between tendon and tendon sheath after acupotomolysis; G is image of tendon longitudinal section of healthy finger, showingsmooth tendon contraction without adhesion; H is clear image of tendon and sheath space in transverse section of healthy finger tendon; I is image of longitudinal section of tendon , showing thickness of tendon sheath decreased and adhesion disappeared after three months of treatment
表1 治疗前后SF-MPQ情况(±s)
Table 1 Short-form McGill pain questionnaire before and after treatment
组别Groups 例数Number of cases PRI VAS PPI
治疗前Before treatment 43 4.6±1.5 5.5±1.3 2.4±0.7
治疗后2周Two weeks after treatment 43 1.5±1.4 1.5±1.5 1.0(0，1.0)
统计值Statistical value   t＝9.700 t＝13.824 Z＝－6.698
P值   <0.001 <0.001 <0.001
表2 治疗前后关节活动受限治疗效果比较(n＝43)
Table 2 Therapeutic effect of joint motion before and after treatment
时间Time 严重受限(例)Severely limited 受限(例)Limitated 轻微受限(例)Slight limitated 正常(例)Normal 正常率(%)Normal rate
治疗前Before treatment 11 27 4 1 2.3*
治疗后2周Two weeks aftertreatment 0 10 7 26 60.4
治疗后3个月Three months after treatment 0 0 0 43 100
χ2值         33.741
P值         <0.001
表3 治疗前后治疗满意度变化情况(n＝43)
Table 3 Patient satisfaction before and after treatment
时间Time 满意(例)Satisfied 良好(例)Good 一般(例)General 不满意(例)Dissatisfied 满意率(%)Satisfaction rate
治疗前Before treatment 1 0 2 40 2.3*
治疗后2周Two weeks after treatment 27 16 0 0 62.8
治疗后3个月Three months after treatment 43 0 0 0 100
χ2值         35.798
P值         <0.001
表4 病灶腱鞘厚度变化比较[mm，(±s)]
Table 4 Comparison of changes of tendon sheath thickness in lesions
组别Groups 例数Number of cases 治疗前Before treatment 治疗后3个月Three months after treatment t值 P值
针刀治疗组Acupotomy treatment group 43 1.14±0.50 0.69±0.58 4.367 <0.001
健康对照组Healthy control group 43 0.55±0.27 0.55±0.27 － －
t值   11.473 1.742    
P值   <0.001 >0.05    
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