Mangukiya H J, Kale A, Mahajan N P, Ramteke U, Manna J
Department of Orthopaedics, B.J Medical College and Sassoon General Hospital, Pune, 411001, India.
Grant Govt Medical College and Sir J.J Group of Hospital, Mumbai, India.
Musculoskelet Surg. 2019 Dec;103(3):269-273. doi: 10.1007/s12306-018-0585-1. Epub 2019 Jan 1.
De Quervain described tenosynovitis of first dorsal compartment more than 120 years ago. Women, particularly of 4th-5th decades, are at more risk of developing disease. Steroid injection has been described as first line of management over many decades, but it is associated with some significant complications like depigmentation of skin, atrophy of subcutaneous tissue, suppurative tenosynovitis and even tendon rupture. Animal studies have also reported increased risk of peritendinous adhesions with steroid injection.
We prospectively managed 46 cases of De Quervain's tenosynovitis with longitudinal incision at tertiary care hospital from 2014 to 2016. There were totally 40 patients with 9 males and 31 females between age group of 28 and 62 years. All patients were evaluated using DASH and VAS scores preoperatively and post-operatively.
The mean preoperative DASH score was 42.26 which reduced to 5.37 post-operatively. The mean preoperative VAS score was 7.30 which reduced to 2.33 post-operatively. Intraoperatively, we found peritendinous adhesions in 8 patients and ganglion arising from first dorsal compartment in one patient. Post-operatively, we found hypertrophic scar in 3 patients and persistent numbness to first dorsal web space due to injury to superficial radial nerve in 2 patients. Six patients had recurrent symptoms and required revision surgery.
Surgical release of De Quervain's tenosynovitis remains the gold standard treatment, and longitudinal incision offers advantage of easy identification of compartment, more complete releases of tendon sheath and peritendinous adhesions and less risk of palmar subluxation of tendons.
120多年前，德·奎尔万描述了第一背侧腱鞘滑膜炎。女性，尤其是40至50多岁的女性，患此病的风险更高。几十年来，类固醇注射一直被视为一线治疗方法，但它会引发一些严重并发症，如皮肤色素沉着、皮下组织萎缩、化脓性腱鞘炎，甚至肌腱断裂。动物研究也报告称，类固醇注射会增加腱周粘连的风险。
2014年至2016年，我们在一家三级护理医院对46例德·奎尔万腱鞘炎患者进行了纵向切口的前瞻性治疗。共有40例患者，年龄在28至62岁之间，其中男性9例，女性31例。所有患者在术前和术后均使用DASH和VAS评分进行评估。
术前DASH评分平均为42.26，术后降至5.37。术前VAS评分平均为7.30，术后降至2.33。术中，我们发现8例患者有腱周粘连，1例患者第一背侧腱鞘出现腱鞘囊肿。术后，我们发现3例患者有肥厚性瘢痕，2例患者因桡神经浅支损伤导致第一背侧蹼间隙持续麻木。6例患者出现复发症状，需要进行翻修手术。
手术松解德·奎尔万腱鞘炎仍然是金标准治疗方法，纵向切口具有易于识别腱鞘、更彻底松解腱鞘和腱周粘连以及肌腱掌侧半脱位风险较低的优点。
