Larsen Christopher G, Fitzgerald Michael J, Nellans Kate W, Lane Lewis B
Department of Orthopaedic Surgery, Northwell Health at North Shore University Hospital and Long Island Jewish Medical Center, New Hyde Park, New York.
Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York.
JBJS Rev. 2021 Sep 10;9(9):01874474-202109000-00009. doi: e21.00069.
»: Most cases of de Quervain tenosynovitis can be managed with nonoperative measures, and the mainstay of treatment is corticosteroid injection (CSI). The use of ultrasound may improve the accuracy of injections and can help to identify and localize injections to separate subcompartments.
»: For patients who are in the third trimester of pregnancy or breastfeeding, there is no contraindication to CSI as studies have shown that it can provide optimal symptomatic relief to the mother without impacting the baby.
»: When nonoperative treatment is unsuccessful, surgical release of the first dorsal compartment (FDC) can provide excellent symptom relief. Open release performed through a longitudinal incision allows for better visualization of the underlying anatomy, resulting in fewer injuries to underlying structures and a lower incidence of hypertrophic scarring compared with a transverse incision.
»: For surgeons who are comfortable performing endoscopic techniques, endoscopic FDC release can result in quicker symptom improvement, superior scar cosmesis, and a lower incidence of radial sensory nerve injury.
»: Studies have shown that FDC release can safely and effectively be performed using the WALANT (wide-awake local anesthesia no tourniquet) technique, which has the potential for cost savings without compromising quality or patient comfort.
大多数桡骨茎突狭窄性腱鞘炎病例可采用非手术措施治疗，治疗的主要方法是皮质类固醇注射（CSI）。超声的使用可提高注射的准确性，并有助于识别和定位注射到不同的子隔室。
对于处于妊娠晚期或哺乳期的患者，CSI没有禁忌证，因为研究表明它可以为母亲提供最佳的症状缓解，而不会影响婴儿。
当非手术治疗不成功时，第一背侧间室（FDC）的手术松解可提供出色的症状缓解。与横向切口相比，通过纵向切口进行的开放松解可以更好地观察潜在的解剖结构，从而减少对潜在结构的损伤，并降低肥厚性瘢痕形成的发生率。
对于熟悉内镜技术的外科医生来说，内镜下FDC松解可导致症状更快改善、瘢痕美容效果更好以及桡神经感觉支损伤的发生率更低。
研究表明，FDC松解可以使用WALANT（清醒局部麻醉无止血带）技术安全有效地进行，该技术有可能节省成本，而不会影响质量或患者舒适度。
