![]() 英語(yǔ)晨讀 · 山東省立醫(yī)院疼痛科英語(yǔ)晨讀已經(jīng)堅(jiān)持10余年的時(shí)間了,每天交班前15分鐘都會(huì)精選一篇英文文獻(xiàn)進(jìn)行閱讀和翻譯。一是可以保持工作后的英語(yǔ)閱讀習(xí)慣,二是可以學(xué)習(xí)前沿的疼痛相關(guān)知識(shí)。我們會(huì)將晨讀內(nèi)容與大家分享,助力疼痛學(xué)習(xí)。 本次文獻(xiàn)選自Jung HS, Baek SH, Lee JS. Is a Steroid Injection in Both Compartments More Effective than an Injection in the Extensor Pollicis Brevis Subcompartment Alone in Patients with de Quervain Disease? A Randomized, Controlled Trial. Clin Orthop Relat Res. 2022,480(4):762-770. 本次學(xué)習(xí)由魏廣福主治醫(yī)師主講。 ![]() Introduction de Quervain disease is a stenosing tenosynovitis of the first extensor compartment of the wrist, which is composed of the abductor pollicis longus (APL) and extensor pollicis brevis (EPB) tendons. It can be treated with nonsurgical methods, such as limiting the use of the thumb, using a brace, injecting a corticosteroid, or, if these processes are ineffective, surgically releasing the tendon sheath of the first dorsal compartment. Among nonsurgical procedures, a steroid injection is often performed for patients with de Quervain disease, with as many as 83% of patients achieving pain relief. 引言 de Quervain病是一種發(fā)生在手腕第一伸肌室(由拇長(zhǎng)展肌APL和拇短伸肌EPB的肌腱組成)的狹窄性腱鞘炎。其可以用非手術(shù)方法治療,如限制拇指的使用,使用支架,注射皮質(zhì)類固醇,或者如果保守治療無效,可以通過手術(shù)松解第一背側(cè)室的腱鞘。在非手術(shù)治療過程中,經(jīng)常對(duì)de Quervain病患者進(jìn)行類固醇注射,多達(dá)83%的患者能獲得疼痛緩解。 ![]() de Quervain disease has been shown to have several anatomic variations that could play an important role in response to treatment. The most relevant variation is the presence of an intracompartmental septum between the APL and EPB tendons. Septation of the first compartment has been reported in 24% to 76% of specimens in cadaver studies and was found to be higher in patients with de Quervain disease. This results in subcompartmentalization of the first compartment, which may make it diffificult for the injection to reach the entire tendon sheath effectively. Therefore, some have suggested that an injection into each subcompartment may make it more likely that injection will provide pain relief. de Quervain病已被證明有幾種解剖學(xué)上的變異,這些變異可能對(duì)治療的反應(yīng)起重要作用。最相關(guān)的變異是APL和EPB肌腱之間存在室間隔。在尸體研究中,有24%至76%的標(biāo)本出現(xiàn)了室間隔,并且在de Quervain病患者中,室間隔的比例更高。這導(dǎo)致了第一室的亞室化,這可能使注射液難以有效地到達(dá)整個(gè)腱鞘。因此,有人提出,向每個(gè)亞室注射可能更有效地緩解疼痛。 ![]() Ultrasound (US) is widely used to assess musculoskeletal disorders because it is noninvasive and inexpensive and does not expose patients to radiation. Studies have reported its usefulness in the diagnosis and treatment of de Quervain disease. In de Quervain disease, the use of US for injection is an accurate method for delivering steroids into both subcompartments, and one study reported that US-guided injections showed better results than the blinded method. However, according to previous studies, the main lesion of de Quervain disease in patients with a septum is a stenosing tenosynovitis of the EPB. In anatomic studies, an intracompartmental septum was usually present at the radial styloid in the first compartment, creating a separate, narrow compartment for the EPB tendon. Furthermore, failure to inject steroids into the EPB sheath could result in persistent symptoms, just as an unreleased, separate EPB subcompartment could lead to persistent symptoms after surgery. Therefore, recent studies have focused on US-guided intrasynovial injections targeting the EPB tendon in the presence of a septum. Although previous studies have compared injections into both subcompartments with injections into a single compartment, to our knowledge, there is no report to date comparing injections into the EPB subcompartment with injections into both subcompartments. 超聲(US)被廣泛用于評(píng)估肌肉骨骼疾病,因?yàn)樗鼰o創(chuàng)且價(jià)格便宜,而且沒有輻射。有研究報(bào)告超聲在診斷和治療de Quervain病方面很有意義。在de Quervain病中,使用超聲引導(dǎo)下注射是將類固醇注入兩個(gè)亞室的準(zhǔn)確方法。一項(xiàng)研究報(bào)告說明,超聲引導(dǎo)下的注射比盲法的效果更好。根據(jù)以前的研究,在有室間隔的病人中,de Quervain病的主要病變是EPB的狹窄性腱鞘炎。在解剖學(xué)研究中,室間隔內(nèi)通常存在于第一室的橈骨指骨處,為EPB肌腱創(chuàng)造了一個(gè)單獨(dú)的、狹窄的亞室。此外,未能向EPB鞘內(nèi)注射類固醇可能導(dǎo)致癥狀無改善,正如未松解的、獨(dú)立的EPB亞室可能導(dǎo)致術(shù)后癥狀無改善一樣。因此,最近的研究集中在超聲引導(dǎo)下的鞘內(nèi)注射,目標(biāo)是有隔膜的EPB肌腱。雖然以前的研究比較了向兩個(gè)亞室的注射和向單一亞室的注射,但據(jù)我們所知,到目前為止還沒有報(bào)告比較單獨(dú)向EPB亞室的注射和同時(shí)向兩個(gè)亞室的注射。 ![]() |
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