微创治疗指屈肌腱狭窄性腱鞘炎的临床应用

目的 探讨关节镜下微创施行腱鞘切开术治疗指屈肌腱狭窄性腱鞘炎的解剖学基础及临床治疗效果。方法在5具新鲜成人上肢标本上，对手掌部指屈肌腱及肌腱周围神经血管组织进行解剖学研究，确定关节镜下治疗指屈肌腱狭窄性腱鞘炎手术入路点及出口、操作标志线、镜下操作层面。依据解剖学研究结果，实施关节镜下治疗指屈肌腱狭窄性腱鞘炎82例，与同期行传统腱鞘切开手术的87例患者进行对比。结果5具解剖标本上关节镜下微创治疗指屈肌腱狭窄性腱鞘炎具有合适的手术入路点及出口、操作标志线、镜下操作层面。临床行关节镜下微创治疗指屈肌腱狭窄性腱鞘炎手术82例，术后按照治疗效果、视觉模拟评分法(visual analogue scale，VAS)进行比较，治疗效果满意，疼痛情况明显改善，手指弹响消失。微创治疗指屈肌腱狭窄性腱鞘炎手术切口细小，伤口不需缝合，术后无明显瘢痕疼痛，恢复时间短，较传统腱鞘切开手术具有优点。结论关节镜下微创治疗指屈肌腱狭窄性腱鞘炎有其解剖学基础，能达到解除肌腱卡压及腱鞘切开的手术目的，是指屈肌腱狭窄性腱鞘炎的有效治疗方法。

Clinical study of minimally invasive treatment of stenosing tenosynovitis of flexor digitorum

Objective To investigate the anatomic basis and clinical effect of arthroscopic minimally invasive tendon sheath incision in the treatment of stenosing tenosynovitis of flexor digitorum. Methods On 5 fresh adult cadaver upper limbs, anatomical studies were carried out on the flexor digitorum tendon of the hand and the neurovascular tissue around the tendon to determine the approach point, exit, operation mark line and operation level for arthroscopic treatment of stenosed tenosynovitis of the flexor digitorum tendon. According to the results of anatomical study, 82 cases of stenosing tenosynovitis of flexor digitorum were treated by arthroscopy, compared with 87 cases with traditional tendon sheath incision. Results On 5 anatomic specimens, arthroscopic minimally invasive treatment of stenosing tenosynovitis of flexor digitorum tendon had appropriate surgical approach and exit, operation mark line and operation level under the microscope. Eighty-two cases of stenosing tenosynovitis of flexor digitorum were treated by minimally invasive surgery with arthroscope. After the operation, according to the treatment effect and visual analog scale (VAS), the treatment effect was satisfactory, the pain situation was obviously improved, and the finger bounce disappeared. Minimally invasive treatment of stenosing tenosynovitis of flexor digitorum tendon has the advantages of small incision, no need to sew the wound, no obvious scar pain and short recovery. Conclusion Arthroscopic minimally invasive treatment of stenosing tenosynovitis of flexor digitorum has its anatomical basis, which can achieve the purpose of relieving tendon compression and tendon sheath incision. It is an effective treatment of stenosing tenosynovitis of flexor digitorum.