Yang Jiaxuan, Ma Bin, Zhong Hao, Zhang Yue, Zhu Jiang, Ni Yong
Pain Department, The Second Affiliated Hospital of Soochow University, Suzhou, Jiangsu, People's Republic of China.
Medical College, Soochow University, Suzhou, Jiangsu, People's Republic of China.
J Pain Res. 2022 Feb 9;15:413-422. doi: 10.2147/JPR.S349869. eCollection 2022.
This study was to assess the safety and effectiveness of ultrasound-guided percutaneous A1 pulley release by acupotomy on unembalmed cadavers.
Sixty digits (from six cadavers, three male and three female) were split into two groups using stratified randomization. All procedures were completed by a single doctor with rich experience in ultrasound-guided treatment. In the acupotomy group, the A1 pulley was released under ultrasound-guided by a needle-knife; while in the needle group, the A1 pulley was released under ultrasound-guided by a 21-gauge needle. Two groups completed six thumbs and 24 fingers, respectively. Another anatomist, blinded to the two techniques, assessed the safety, including the minimum distance between the incision and the neurovascular; flexor tendon, neurovascular and A2 pulley injury or not. Completeness release of the A1 pulley was recorded as effectiveness.
No neurovascular or A2 pulley injuries were recorded. However, the incision of the thumb in both groups biased to the radial side ( <0.05), while the incision of the finger biased to the ulnar side ( <0.05). No significant flexor tendon injury was found, and only five cases (16.7%) had minor scratches in the acupotomy group; while in the needle group, 15 cases had minor scratches and lacerations occurred in three cases. The flexor tendon injury rate was 60%. Compared with the needle, ultrasound-guided acupotomy release is safer ( <0.05). The ultrasound-guided acupotomy technique was significantly more likely to result in a complete A1 pulley release compared to the needle technique (28 of 30 [93.3%] versus 11 of 30 [36.7%]; <0.05).
Ultrasound-guided percutaneous A1 pulley release by acupotomy is a safe and effective technique. When releasing the thumb by ultrasound-guided, be careful not to bias to the radial side to avoid neurovascular injury, while when releasing a finger, be careful not to bias to the ulnar side.
本研究旨在评估超声引导下经皮针刀松解A1滑车在未防腐尸体上的安全性和有效性。
使用分层随机化方法将60个手指（来自6具尸体，3男3女）分为两组。所有操作均由一名在超声引导治疗方面经验丰富的医生完成。针刀组在超声引导下用针刀松解A1滑车；针组在超声引导下用21号针松解A1滑车。两组分别完成6个拇指和24个手指的操作。另一名对两种技术不知情的解剖学家评估安全性，包括切口与神经血管的最小距离；屈肌腱、神经血管和A2滑车有无损伤。记录A1滑车的完全松解情况作为有效性指标。
未记录到神经血管或A2滑车损伤。然而，两组拇指的切口均偏向桡侧（P<0.05），而手指的切口偏向尺侧（P<0.05）。未发现明显的屈肌腱损伤，针刀组仅5例（16.7%）有轻微划痕；针组有15例有轻微划痕，3例出现撕裂伤。屈肌腱损伤率为60%。与针相比，超声引导下针刀松解更安全（P<0.05）。与针技术相比，超声引导下针刀技术更有可能导致A1滑车完全松解（30例中有28例[93.3%]，而30例中有11例[36.7%]；P<0.05）。
超声引导下经皮针刀松解A1滑车是一种安全有效的技术。超声引导下松解拇指时，注意不要偏向桡侧以避免神经血管损伤，而松解手指时，注意不要偏向尺侧。
