Department of Orthopedic Surgery, Imam Khomeini Hospital, Jondishapur University of Medical Sciences, Ahwaz, Iran.
Arch Iran Med. 2010 Jul;13(4):270-4.
There is no consensus in the treatment of de Quervain's tenosynovitis, but wrist support with or without local corticosteroid injection has been considered as an effective treatment modality. Some patients have expressed reluctance for steroid injections because of the fear of probable adverse reactions. This study was performed to compare the outcome of methylprednisolone acetate injection plus thumb spica cast versus cast alone for the treatment of de Quervain's tenosynovitis.
This randomized prospective study was conducted from January 2005 to July 2008 in the orthopedic clinics of our hospital and private offices. A total of 73 patients with de Quervain's tenosynovitis were managed with either of these methods: 1) injection of methylpredmisolone acetate in the first dorsal compartment of the wrist followed by wrist thumb spica cast. 2) casting alone. Wrist casting duration in both groups was one month and the patients were followed for 6 months.
In the first group, a total of 37 patients were included (injection plus wrist immobilization by cast), and 36 patients in the second group (wrist casting alone). The mean age was 32.6 years (21 - 61 years) in all patients. There were 63 women and 10 men. Overall success rate was 86.5% in the first and 36.1% in the second groups, with a significant difference for both groups with respect to pain score and cure rate (P<0.05). Temporary pain was the most common adverse reaction at the site of injection and was noted in 40% of patients. Despite this adverse reaction which was related to methylprednisolone injection, a higher success rate was seen in the injection group in comparison to patients treated solely by casting.
Support of the wrist with casting alone had less favorable outcome in de Quervain's tenosynovitis. Adding methylprednisolone acetate injection into the first dorsal compartment of the wrist is necessary for more optimal results.
在治疗狭窄性腱鞘炎方面尚无定论，但腕关节支具固定加或不加局部皮质类固醇注射已被认为是一种有效的治疗方法。一些患者由于担心可能的不良反应而不愿意接受类固醇注射。本研究旨在比较醋酸甲泼尼龙注射加拇指斯皮茨石膏管型与单纯石膏管型治疗狭窄性腱鞘炎的疗效。
本随机前瞻性研究于 2005 年 1 月至 2008 年 7 月在我院骨科门诊和私人诊所进行。共有 73 例狭窄性腱鞘炎患者采用以下方法治疗：1）腕关节第一背侧间隙注射醋酸甲泼尼龙，然后用拇指斯皮茨石膏管型固定腕关节。2）单纯石膏管型固定。两组患者的腕关节石膏固定时间均为 1 个月，并随访 6 个月。
在第一组中，共有 37 例患者（注射加腕关节固定石膏管型），第二组 36 例（单纯腕关节固定石膏管型）。所有患者的平均年龄为 32.6 岁（21-61 岁）。其中女性 63 例，男性 10 例。第一组的总有效率为 86.5%，第二组为 36.1%，两组间疼痛评分和治愈率均有显著差异（P<0.05）。注射部位的暂时性疼痛是最常见的不良反应，40%的患者出现这种不良反应。尽管这种不良反应与甲泼尼龙注射有关，但与单纯石膏管型治疗的患者相比，注射组的成功率更高。
单纯腕关节支具固定治疗狭窄性腱鞘炎效果较差。在腕关节第一背侧间隙注射醋酸甲泼尼龙是获得更优结果的必要手段。
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