改良的B超引导下弯针线环腱鞘松解术技术

doi:10.3877/cma.j.issn.1674-134X.2026.01.014

目的

本技术旨在克服传统开放手术创伤大、小针刀盲法操作风险高的缺点，探索一种在超声引导下可视化、微创且安全的腱鞘松解新术式。

方法

设计并应用"混合盾形针（HJ）"：结合套管针和钝头针芯。同时，全程高频超声实时引导：将弯针带线环经皮下绕经A1滑车，利用线环切割完成腱鞘松解。本技术避免使用锐针，最大限度保护肌腱、神经血管等周围结构。

结果

操作可行，松解即刻效果良好，同时创伤小，目前观察到的术后并发症少。

结论

改良的B超引导下弯针线环腱鞘松解术兼具微创、安全、可视化优势，或可作为手指狭窄性腱鞘炎的新治疗选择；但其广泛推广仍需更长期随访及大样本验证。

关键词: 腱鞘炎, 超声检查, 最小侵入性外科手术

Objective

To overcome the drawbacks of traditional open surgery and the risk of iatrogenic injury of percutaneous needle techniques by developing a fully visualized, minimally invasive approach for trigger-digit release.

Methods

A hybrid shield needle (hybrid-J shield needle, HJ) was designed that combined a blunt stylet and cannula. Under continuous high-resolution ultrasound guidance, a curved needle carrying a thread loop was passed around the A1 pulley; the loop was then used to cut and release the tendon sheath without sharp instrumentation, so that the tendon and adjacent neurovascular structures were protected.

Results

The procedure was technically feasible and provided immediate and adequate release with minimal trauma, while few post-operative complications was observed.

Conclusion

The modified Ultrasound-guided curved-needle loop release offers a minimally invasive, safe, and fully visualized alternative for trigger-digit stenosing tenosynovitis, while longer follow-up and larger series are required to confirm its broad applicability and sustained efficacy.

Key words: Tenosynovitis, Ultrasonography, Minimally invasive surgical procedures

图1 HJ针（混合盾形针）。图A为套管针、针芯总览及针芯放大示意图，白色圆圈示钝头针芯，用于肌腱表面穿针；锐头针芯如黑色圆圈所示，用于破皮；图B为套管针、针芯总览及套管针放大示意图，白色圆圈示套管针可套入针芯和置入线

Figure 1 HJ needle (hybrid-J shield needle). A is the appearance of stylet and cannula with magnified view of blunt and sharp stylets, the white circle shows the blunt-tip stylet used for passing the needle over the tendon surface, and the black circle shows the sharp-tip stylet used for skin penetration; B is the appearance of stylet and outer cannula with magnified view of cannula, the white circle shows the entrance of cannula into which the stylet can be inserted with the suture

图2 改良的B超引导下弯针线环腱鞘松解术手术过程示意图。图A为锐头针芯在近端界限上方破皮；图B为从破皮处插入钝头针芯；图C为B超引导下钝头针芯穿过腱鞘下方，锐头针芯在远端界限上方破皮；图D为钝头针芯从破口处穿出；图E为套管针与钝头针芯结合；图F为在钝头针芯引导下，套管针从远端破口向近端破口穿出，并从套管处穿入缝合线；图G为B超引导下钝头针芯穿过腱鞘上方，并用套管针完成接力，从套管处穿线；图H为形成环绕腱鞘的线环，来回拉动线割断腱鞘；图I为腱鞘松解完成

Figure 2 Process of modified ultrasound-guided curved-needle loop tendon sheath release. A is sharp stylet punctures the skin proximal to the release zone; B shows that blunt stylet is introduced through the same skin incision; C shows that under ultrasound guidance the blunt stylet is brought beneath the tendon sheath, the sharp stylet then punctures the skin distal to the release zone; D shows that blunt stylet is brought out through the distal skin incision; E shows cannula is mounted over the blunt stylet; F shows that under the guidance of blunt stylet, the cannula is passing from distal to proximal incisionwith suture through the trocar; G shows that the blunt stylet is passing above the tendon sheath under ultrasound guidance and the cannula is used to complete the procedure by putting the suture into the entrance of cannula; H shows that the loop surrounding the tendon sheath is completed, pulling the loop back and forth to cut the tendon sheath; I shows that the tendon sheath release is completed

图3 超声下掌指关节部位结构。图A为超声下近端掌指关节部位，结构清晰可见；图B示超声下针的形态（白色箭头）注：MC-掌骨；FT-屈肌腱；AP-A1滑车

Figure 3 Ultrasound anatomy of the metacarpophalangeal joint. A is proximal metacarpophalangeal joint, showing clearly the joint structure; B shows needle appearance under ultrasound view (white arrow)Note: MC-metacarpal；FT-flexor tendon；AP-A1 pulley

图4 右手第5手指近端掌指关节腱鞘下方穿线过程。图A为锐头针近端破皮；图B为超声引导下从破皮处进钝头针进入腱鞘下方，白色箭头示针的位置；图C为套管针从远端插入与钝头针芯结合；图D为超声下见套管针与钝头芯穿过腱鞘下方（白色箭头）；图E为腱鞘下方穿线完成；图F为超声下确认线（白色箭头）穿入腱鞘下方注：MC-掌骨；FT-屈肌腱；AP-A1滑车

Figure 4 Threading process beneath the tendon sheath at the proximal metacarpophalangeal joint of the right fifth finger. A is sharp stylet puncturing the skin proximally; B shows that blunt stylet is brought under ultrasound guidance through the puncture site into the subsheath space, white arrow pointing at stylet position; C shows that cannula is inserted distally and coupled to the blunt stylet; D is ultrasound image showing the cannula and blunt stylet passing beneath the tendon sheath (white arrow); E shows that subsheath threading is completed. F shows that ultrasound confirms the suture (white arrow) lies beneath the tendon sheathNote: MC-metacarpal；FT-flexor tendon；AP-A1 pulley

图5 右手第5手指近端掌指关节腱鞘上方穿线过程超声影像。图A为腱鞘上方穿入钝头针芯；图B为在钝头针芯的引导下穿入套管针；图C为超声下掌指关节纵切面，图D为横切面，示针（黄色箭头）穿过腱鞘上方，白色箭头为线；图E为超声下确认线环（白色箭头）成功包绕腱鞘注：FT-屈肌腱；AP-A1滑车

Figure 5 Ultrasound images of threading process above the tendon sheath at the proximal metacarpophalangeal joint of the right fifth finger. A is blunt stylet inserting above the tendon sheath; B shows that cannula is brought over the blunt stylet; C is longitudinal view and D is transverse view of metacarpophalangeal joint under ultrasound, showing the stylet (yellow arrow) passing above the tendon sheath; white arrow showing the suture; E shows ultrasound confirming that the suture loop (white arrow) has successfully encircled the tendon sheathNote: FT-flexor tendon；AP-A1 pulley

图6 套管针验证右手第5手指近端掌指关节腱鞘松解效果超声影像。图A~B为掌指关节纵切面，见针（白色箭头）在肌腱上方自由上下摆动；图C~D为掌指关节横切面见针（白色箭头）在肌腱上方自由上下摆动，证实腱鞘的松解完全注：FT-屈肌腱

Figure 6 Confirmation of tendon sheath release in the right fifth finger metacarpophalangeal joint using the cannula with ultrasound images. A~B is longitudinal ultrasound view, showing the cannula (white arrows) moving freely in the tendon sheath; C~D is transverse ultrasound view, showing the cannula (white arrows) moving freely in the tendon sheath, confirming complete release of the tendon sheathNote: FT-flexor tendon

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摘要

选择文件类型/文献管理软件名称

选择包含的内容

Modified ultrasound-guided curved-needle loop release technique

模态框（Modal）标题

选择文件类型/文献管理软件名称

选择包含的内容

Modified ultrasound-guided curved-needle loop release technique