Rothman Institute, Department of Orthopaedic Surgery, Thomas Jefferson University, 925 Chestnut St, Philadelphia, PA 19107, USA.
Clin Orthop Relat Res. 2012 Jul;470(7):1925-31. doi: 10.1007/s11999-012-2369-5. Epub 2012 May 3.
Nonsurgical management of de Quervain's tenosynovitis often includes corticosteroid injections. If the injection does not enter the compartment, or all subcompartments, response to the injection is variable. To ensure proper location of injections we evaluated the role of ultrasound.
QUESTIONS/PURPOSES: We determined (1) the incidence of two or more subcompartments, (2) the incidence of anatomic variations during surgical release after failed injections, and (3) the relief of pain after ultrasound-guided injections.
A prospective series of 40 consecutive patients (42 wrists) diagnosed with de Quervain's tenosynovitis by clinical examination were referred to a radiologist for an ultrasound-guided injection. The radiologist injected the first dorsal compartment and noted any septations. Patients returned for followup where outcomes, DASH, and VAS scores were calculated. The treating surgeon was blinded to any anatomic variations. Followup was at 6 weeks and a minimum of 6 months (mean, 6 weeks, range, 3-17 months; mean, 11 months, range, 7-18 months). Four patients were lost to followup.
Multiple subcompartments were noted in 22 of 42 (52%) wrists. At the 6-week followup, 36 of the 37 wrists examined in 36 patients (97%) had at least partial resolution of symptoms. Multiple subcompartments were identified in 52% of cases. At last followup, the mean DASH and VAS scores were 18.4 and 2.2, respectively. However 14% of wrists had recurrence of symptoms, all of which had subcompartments on ultrasound. No adverse effects from the injections were noted.
We found ultrasound-guided injections to be useful for treatment of de Quervain's tenosynovitis. Our success with ultrasound-guided injections was slightly better than that reported in the literature and without adverse reactions.
非手术治疗德奎文氏腱鞘炎通常包括皮质类固醇注射。如果注射未进入鞘管或所有亚鞘管，则注射反应各不相同。为了确保注射部位正确，我们评估了超声的作用。
问题/目的：我们确定了（1）两个或更多亚鞘管的发生率，（2）注射失败后手术松解时解剖变异的发生率，以及（3）超声引导注射后的疼痛缓解情况。
连续 40 例（42 只腕）临床诊断为德奎文氏腱鞘炎的患者被转诊给放射科医生进行超声引导注射。放射科医生注射了第一背侧间隔，并注意到任何隔膜。患者返回进行随访，计算 DASH 和 VAS 评分。治疗外科医生对任何解剖变异均不知情。随访时间为 6 周和至少 6 个月（平均 6 周，范围 3-17 个月；平均 11 个月，范围 7-18 个月）。有 4 例患者失访。
在 42 只腕中，有 22 只（52%）存在多个亚鞘管。在 6 周的随访中，36 例患者中的 37 只腕（97%）至少有部分症状缓解。在 52%的病例中发现了多个亚鞘管。在最后一次随访时，平均 DASH 和 VAS 评分分别为 18.4 和 2.2。然而，14%的腕部出现症状复发，所有这些腕部在超声下均存在亚鞘管。未发现注射的不良反应。
我们发现超声引导注射对德奎文氏腱鞘炎的治疗有效。我们使用超声引导注射的成功率略高于文献报道，且无不良反应。
