关节镜下治疗桡骨茎突狭窄性腱鞘炎的病例对照研究

目的 :探讨关节镜下治疗桡骨茎突狭窄性腱鞘炎的临床疗效。方法 :2009年8月至2013年7月收治桡骨茎突狭窄性腱鞘炎患者99例,分为3组:关节镜治疗组(32例,男6例,女26例),外科手术切开腱鞘组(34例,男7例,女27例)和封闭治疗组(33例,男6例,女27例)。观察并比较3组在治疗前、治疗后1周和治疗后1个月腕部及拇指静息状态下疼痛程度、活动状态下疼痛程度、局部压痛程度、局部肿胀情况、腕部及拇指活动情况及总体症状评分方面的差异。同时计算3组在不同时间点的总有效率。结果:随访1周和1个月后,关节镜治疗组和外科手术切开腱鞘组活动疼痛评分低于封闭治疗组(P=0.044和0.039)。1个月后关节镜治疗组和外科手术切开腱鞘组局部压痛评分低于封闭治疗组(P=0.017)。随访1周和1个月后关节镜治疗组和外科手术切开腱鞘组总体症状评分均低于封闭治疗组(P=0.007和0.015)。治疗后随访1周关节镜治疗组、外科手术切开腱鞘组和封闭治疗组总有效率比较,差异无统计学意义(P=0.213),但随访1个月后总有效率差异有统计学意义(P=0.006)。结论:相比传统手术切开腱鞘治疗和封闭治疗,关节镜下治疗桡骨茎突狭窄性腱鞘炎疗效满意,手术创伤小,安全性高,并发症少,在狭窄性腱鞘炎治疗中有一定的优越性。

Case-control study on clinical effects of arthroscopic treatment for stenosing tenosynovitis of radial styloid process

Objective: To investigate the clinical effect of arthroscopic treatment for stenosing tenosynovitis of radial styloid process.Methods: Ninety-nine patients diagnosed as stenosing tenosynovitis of radial styloid process from August,2009 to July,2013 were divided into three groups,including arthroscopic treatment group(32 cases),traditional operation group (34 cases) and local blocking therapy group(33 cases). Ache,tenderness,swollen situations and movement degrees of wrist joints and thumbs were observed before treatment and one week and one month after treatment. Total effective rates were calculated.Results: Pain score of the wrist and thumb in activity state was lower in arthroscopic treatment group and traditional operation group than that in local blocking therapy group one week and one month after treatment(P=0.044,0.039). Local pain score was lower in arthroscopic treatment group and traditional operation group than that in local blocking therapy group one month after treatment(P=0.017). The total symptom score was lower in arthroscopic treatment group and traditional operation group than that in local blocking therapy group one week and one month after treatment(P=0.007,0.015). The effective rates one week after treatment in arthroscopic treatment group,traditional operation group and local blocking therapy group were respectively 96.9%,94.1% and 84.8%,without significant differences(P=0.213). The effective rates one month after treatment in these three groups were respectively 93.8%,97.1% and 72.7%,with significant differences(P=0.006).Conclusion: Compared with traditional operation and local blocking therapy,arthroscopic treatment has certain effects for the treatment of stenosing tenosynovitis of radial styloid process,with less operation trauma and complications,and it is worthy of clinical promotion.