Karakaplan Mustafa, Ertem Kadir, Canbay Ali, Aslantürk Okan, Yoloğlu Saim
Orthopaedics and Traumatology Department, Turgut Özal Medical Center, İnönü University Medical School, Malatya, Turkey.
Orthopaedics and Traumatology Department, Turgut Özal Medical Center, İnönü University Medical School, Malatya, Turkey.
Acta Orthop Traumatol Turc. 2019 Jan;53(1):40-44. doi: 10.1016/j.aott.2018.10.004. Epub 2018 Nov 5.
We aimed to present preliminary result of one portal endoscopic assisted release of first dorsal compartment at wrist in a case series with de Quervain disease as a minimal invasive surgical method.
The patients, who underwent an endoscopic-assisted release of the first extensor compartment for de Quervain's disease by same hand surgeon between 2015 and 2017, were retrospectively analyzed. Operative treatment was considered if the patients did not respond to non-operative treatment including oral anti-inflammatory medications, splinting, and steroid injection. Surgical release was recommended after minimum four months of unsuccesful non-operative treatment, including a steroid injection. 10 wrists were treated with one portal endoscopic assisted release. All patients were evaluated at an average of 16.1 months follow-up using visual analog scale (VAS) pain ratings and the Disabilities of Arm, Shoulder and Hand (DASH) score.
The mean operating time was 13.9 min (range, 10-21min). The mean VAS and DASH scores were improved from 8.2 to 1.9 and 70.51 to 2.81 respectively. No significant difference was found between operated and non-operated arms in postoperative pinch and strengths. Transient superficial radial nerve paresthesia (two wrists) and significant scar tenderness (one) were identified in three cases. There was no patient that complain of unsightly scar and tendon subluxation.
One portal endoscopic assisted release of the extensor compartment is an effective and safe minimal invasive procedure with similar complication rates reported previously in open and endoscopic procedures in patients with de Quervain's disease who are unresponsive to non-operative treatments.
Level IV Therapeutic Study.
我们旨在呈现一系列以桡骨茎突狭窄性腱鞘炎为研究对象的病例中，采用单通道关节镜辅助下腕部第一背侧腱鞘松解术这一微创手术方法的初步结果。
回顾性分析2015年至2017年间由同一位外科医生采用关节镜辅助下第一伸肌支持带松解术治疗桡骨茎突狭窄性腱鞘炎的患者。若患者对包括口服抗炎药物、夹板固定和类固醇注射在内的非手术治疗无反应，则考虑进行手术治疗。在至少4个月的非手术治疗（包括类固醇注射）无效后，建议进行手术松解。10例腕部采用单通道关节镜辅助下松解术进行治疗。所有患者在平均16.1个月的随访中，使用视觉模拟评分（VAS）疼痛评分和上肢、肩部和手部功能障碍（DASH）评分进行评估。
平均手术时间为13.9分钟（范围10 - 21分钟）。平均VAS和DASH评分分别从8.2改善至1.9以及从70.51改善至2.81。术后捏力和力量方面，手术侧与非手术侧之间未发现显著差异。3例患者出现了短暂的桡浅神经感觉异常（2例腕部）和明显的瘢痕压痛（1例）。没有患者抱怨瘢痕难看或肌腱半脱位。
对于非手术治疗无效的桡骨茎突狭窄性腱鞘炎患者，单通道关节镜辅助下伸肌支持带松解术是一种有效且安全的微创手术，其并发症发生率与先前开放性和关节镜手术报道的相似。
IV级治疗性研究。
