镰状刀片治疗晚期手指屈肌狭窄性腱鞘炎

1998—2005年，我们采用镰状刀片手术治疗晚期手指屈肌狭窄性腱鞘炎患者69例，临床床疗效满意。     

小针刀治疗屈指肌腱狭窄性腱鞘炎疗效的Meta分析

目的 :通过系统评价,比较小针刀疗法和封闭疗法治疗屈指肌腱狭窄性腱鞘炎的疗效以及安全性。方法 :检索中国知网(1962~2015年)、维普数据库(1993~2015年)、万方数据(2000~2015年)、pubmed中文数据库(1994~2015年),并且应用手工输入法检索相关医学期刊,纳入小针刀疗法与封闭疗法对比治疗屈指肌腱狭窄性腱鞘炎的随机对照试验,经2名评价者按要求对筛选后的资料进行交叉核对后,采用Rev Man 5.2软件进行Meta分析。结果:共纳入7个随机对照试验,包含患者1 174例,但没有筛选到高质量文献。Meta分析结果显示,小针刀组治疗屈指肌腱狭窄性腱鞘炎总有效率明显高于对照组,OR=9.07,95%CI[4.64,17.76],Z=6.44,P0.00001;小针刀组治疗屈指肌腱狭窄性腱鞘炎痊愈率明显高于对照组,OR=7.86,95%CI[5.75,10.74],Z=12.93,P0.00001。结论:小针刀治疗屈指肌腱狭窄性腱鞘炎疗效优于封闭疗法。由于纳入试验数目有限且文献质量较低,漏斗图表现出发表偏倚,需设计更严格的随机对照试验来进一步验证上述结论。     

Infliximab induces remission in cryptogenic multifocal ulcerous stenosing enteritis:First case

We present the case of a 29-year-old patient with a history of abdominal pain and vomiting.Based on wireless video capsule findings he was previously diagnosed with ileal Crohn’s disease at a different institution,although the clinical and radiological picture was not typical and the response to corticosteroids was poor.We performed a single-balloon enteroscopy showing a short,ulcerous stenosis 50 cm proximal from Bauhin’s valve.The endoscopic and clinical histopathological findings were compatible with cryptogenic multifocal ulcerous stenosing enteritis(CMUSE).High dose corticosteroids were again started,without effect.The monoclonal tumor necrosis factor-α(TNF-α) antibody infliximab was added to the medical therapy.After induction therapy,both clinical and endoscopic amelioration was obtained.Larger case studies are needed to confirm the efficacy of TNF-α inhibition in steroid refractory CMUSE.     

Achilles Tendon Infection Due to Mycobacterium chelonae

Atypical tuberculous tenosynovitis of the foot and ankle is extremely rare. The determination of the Mycobacterium species is essential because resistance of atypical mycobacterial strains to antituberculous drugs is often encountered. We report a case of Mycobacterium chelonae paratendinous and intratendinous infection involving the Achilles tendon. Repeat aggressive irrigation and debridement procedures, coupled with removal of foreign materials and the appropriate use of prolonged antibiotic therapy, can result in a successful long-term outcome.     

结核感染T细胞斑点试验在手、腕部腱鞘结核诊断中的应用评价

=O4 探讨结核感染T细胞斑点试验(T-cell spot of Tuberculosis,T-SPOT.TB)在手、腕部腱鞘结核诊断中的临床应用价值。方法通过对2012年1月至2018年1月我院收集 64例怀疑手、腕部腱鞘结核临床资料进行回顾性分析,根据病理诊断及临床表现判断有无结核分枝杆菌感染;全部病例均经过T-SPOT.TB和胶体金标法分别进行体外γ-干扰素释放试验和血清结核抗体检测,采用Kappa、χ²检验进行统计学分析。-结果- 共收集分析相关病例64例,其中诊断为手、腕部腱鞘结核(结核病例)21例,非手、腕部腱鞘结核(非结核病例)43例。经T-SPOT.TB检测,结核病例阳性者20例,非结核病例阴性者40例,灵敏度为95.2%,特异度为93.0%,阳性预测值为87.6%,阴性预测值为97.6%。经胶体金标法检测血清结核抗体,结核病例阳性者5例,非结核病例阴性者37例,灵敏度为23.8%,特异度为86.0%,阳性预测值为45.4%,阴性预测值为69.8%。与临床诊断比较,T-SPOT.TB和胶体金标法的Kappa值分别为0.862和0.112,T-SPOT.TB比胶体金标法具有更好的一致性,且灵敏度、阳性预测值和阴性预测值均明显更高,差异有统计学意义(P<0.05)。-结论- T-SPOT.TB在手、腕部腱鞘结核诊断中具有良好的辅助诊断价值。     

超声用于腱鞘滑车系统研究进展

腱鞘滑车系统位置表浅而结构精细,高频超声可用于检查相关病变,如诊断及治疗指屈肌腱狭窄性腱鞘炎、评估系统性疾病和系统性硬化症累及腱鞘滑车系统等。本文对腱鞘滑车系统超声表现及相关研究进展进行综述。     

Outcome of low level lasers versus ultrasonic therapy in de Quervain's tenosynovitis

Background:

de Quervain''s tenosynovitis is an inflammation of abductor pollicis longus (APL) and extensor pollicis brevis (EPB) muscle tendon sheaths at the level of radial styloid process. Its conservative management includes nonsteroidal anti-inflammatory drugs, wrist and thumb immobilization, ultrasonic therapy (US Th.) and low level laser therapy (LLLT). Literature is scanty on comparative efficacy of US Th. and LLLT for its management. This prospective study evaluates outcome of US Th. versus LLLT in de Quervain''s disease.

Materials and Methods:

Thirty patients clinically diagnosed de Quervains tenosynovitis were included in the study and randomly assigned to two groups. The average age was 36 years (range: 21-45 years). One group was given LLLT and the other US Th. for a total of 7 exposures on alternate days. The clinical criteria used were Finkelstein''s test, tenderness over radial styloid (Ritchie''s tenderness scale), grip strength, pain (visual analog scale [VAS]) and radiological criteria was ultrasonographic assessment of change in thickness of APL and EPB tendon sheath. They were measured before commencement and at the end of seven sessions of therapy, as per standard procedure.

Results:

Significant improvement was seen within both groups in the following outcome measures assessed: Ritchie''s tenderness scale, grip strength and VAS. Finkelstein''s test was not significantly improved in either groups. Ultrasonographic measurement of tendon sheath diameters, the mediolateral (ML), and anteroposterior (AP) diameters was not found to be significantly different in the US Th. group and the laser therapy group after treatment. On comparing both the groups, no statistically significant difference was found. However, looking at the mean values, the grip strength and VAS showed better improvement in the US Th. group as compared to the laser therapy group.     

Stenosing ureteritis in Henoch–Schönlein purpura: Report of two cases

Stenosing ureteritis (SU), a rare complication of Henoch–Schönlein purpura (HSP), typically presents with severe symptoms. We report the cases of two HSP patients presenting with gross hematuria, blood clotting, and colicky flank pain, followed by purpura on the lower extremities. Early‐stage ultrasonography indicated hydronephrosis, thickened renal pelvic mucous membrane, and ureteral dilatation (UD), suggesting HSP complicated with SU. After early SU treatment with prednisolone, kidney function, thickened renal pelvic mucous membrane, and UD progressively normalized and the pain gradually disappeared. Regular ultrasonography of HSP patients from the onset of gross hematuria can be useful to detect early SU and facilitate conservative therapy with prednisolone. Diagnosis of SU can be easily missed by assuming HSP nephritis, particularly owing to the non‐specific symptoms. Common characteristics as well as treatment methods and prognosis of SU are given in the literature review.