Weiss A P, Akelman E, Tabatabai M
Department of Orthopaedics, Brown University School of Medicine, Rhode Island Hospital, Providence 02903.
J Hand Surg Am. 1994 Jul;19(4):595-8. doi: 10.1016/0363-5023(94)90262-3.
This study compared the use of a mixed steroid/lidocaine injection alone, an immobilization splint alone, and the simultaneous use of both in improving symptoms in de Quervain's disease. Ninety-three wrists were included in the study, with an average follow-up examination of 13 months. Complete relief of symptoms was noted in 28 of 42 wrists receiving an injection alone, 8 of 14 wrists receiving both an injection and splint, and 7 of 37 wrists receiving a splint alone. No significant difference was noted between the injection alone and injection plus splint groups. A significant difference was seen between the injection alone and splint alone groups and the injection/splint and splint alone groups. Twenty of 45 wrists that underwent operative release demonstrated a septum at the first dorsal compartment. When the need for operative release was used as an outcome result for treatment failure, the injection alone and splint alone groups demonstrated significance. We recommend the use of a mixed steroid/lidocaine injection alone as the initial treatment of choice in this condition. No additional benefit is appreciated by the addition of splint immobilization and, in fact, patients are less restricted with a lower financial burden without its use.
本研究比较了单独使用混合类固醇/利多卡因注射、单独使用固定夹板以及两者同时使用对改善桡骨茎突狭窄性腱鞘炎症状的效果。该研究纳入了93例手腕，平均随访13个月。单独接受注射的42例手腕中有28例症状完全缓解，接受注射加夹板治疗的14例手腕中有8例症状完全缓解，单独接受夹板治疗的37例手腕中有7例症状完全缓解。单独注射组与注射加夹板组之间未发现显著差异。单独注射组与单独夹板组以及注射/夹板组与单独夹板组之间存在显著差异。接受手术松解的45例手腕中有20例在第一背侧间室可见隔膜。当将手术松解的需求作为治疗失败的结果时，单独注射组和单独夹板组具有显著性差异。我们建议单独使用混合类固醇/利多卡因注射作为这种情况的初始首选治疗方法。添加夹板固定并无额外益处，事实上，不使用夹板时患者受限更少且经济负担更低。
