| Objective:To observe the pathological features of Trigger finger(TF)by musculoskeletal ultrasound,providing a objective imaging diagnosis for it.To summarize the shape and location of the A1 pulley and its surrounding tissues by xltrasound,normalizing the Needle-knife operation process.To evaluate the clinical effect of ultrasound-guided needle-knife on TF.Methods:Sixty patients with Sixty-nine fingers were selected in the Third Affiliated Hospital of Beijing University of Chinese Medicine.First,the pathological changes of the A1 pulley and its adjacent tissues were observed and recorded under musculoskeletal ultrasound.Second,the the location,thickness,width of the A1 pulley and its distance with nerves and vessles were measured,and then marked it on the body surface.Then,Operated percutaneous release by TCM Small Needle-Knife for 1 time.The VAS scores and Quinnell grading standards were recorded at each time point,including before treatment,after the treatment of 24 hours,2 weeks,and lmonth.Last,all patients were followed up after 1 month to evaluate the curative effect according to Standard of TCM Syndrome And Diagnosis.Results:1.Features of pathology under ultrasound:? 79.71%(55/69)showed the tendon is fusiform enlarged and can be compressed by the tendon sheath into a gourd shape,and the activity is limited.? 94.20%(65/69)showed tendon sheath thickened and got hypoechoic,the maximum thickness was to 2.6mm.?34.78%(24/69)showed thin liquid dark zone,the thickness was 0.8-4.1mm.?5.80%(4/69)showed Calcification,with hyperechoic spots around the tendon sheath.?15.94%(11/69)showed blood flow signs.?2.90%(2/69)had no obvious pathological changes.2.The shape and location of the A1 pulley and its surrounding tissues under ultrasound:? The A1 pulley thickness of healthy fingers is 0.2-0.8mm(0.45 ±0.21mm),with diseased fingers 0.6-2.6mm(1.54 ± 0.16mm)correspondingly.The difference was statistically significant with P<0.05.?The tendon thickness of healthy fingers is 2.1-4.6mm(3.40 ± 0.52mm),with diseased fingers 2.2-5.7mm(3.98 ±0.24mm)correspondingly.The difference was statistically significant with P<0.05.?A1 pulley widths:Thumb 5.4 ± 1.4mm,index finger 6.8 ± 1.3mm,middle finger 7.1 ±2.0mm,ring finger 7.2 ±1.1mm,little finger 6.5±0.9mm,means 6.7mm.?The distance of A1 pulley proximal edge and palmprint:Thumb 3±0.1mm,index finger 5±0.2mm,middle finger 3±0.1mm,ring finger 3±0.2mm,little finger 2±0.1mm.means 3.2mm.?The distance of A1 pulley axis and digital vein,arter and nerve:Thumb 9±0.1mm,index finger 8±0.2mm,middle finger 8±0.1mm,ring finger 8±0.2mm,little finger 6?0.1mm,means 8mm.3.Curative effect evaluation:Paired sample Wilcoxon signed-rank test were used to analyse this statistic:the VAS scores and Quinnell grading standards recorded at each time point,including before treatment,after the treatment of 24 hours,2 weeks,and lmonths,which all had significantly differences with P<0.05.Last,all patients were evaluated the curative effect according to Standard of TCM Syndrome And Diagnosis:19 cases were cured,accounted for 31.7%;25 cases were markedly effective,accounted for 41.7%;11 cases were effective,accounted for 18.3%;5 cases were ineffective;accounted for 8.3%.The cure rate was 31.7%,totally efficient rate was 91.7%.Conclusions:1.The tendon enlargement and the A1 pulley thickness has high specificity and diagnostic value under ultrasound.2.Standard release operation by a Needle-knife for TF:the puncture entry point should keep a certain distance with the palmprint with the average of 3.2mm.The release distance should be 6.7mm to the distal with depth 1.5mm commonly.At same time,keep away from the digital bilateral vessels and nerves with the distance of 8mm.3.The treatment has high location accuracy and excellent effectiveness for TF through musculoskeletal ultrasound with needle-knife.The treatment shows operation safety and significantly improvement of the patients quality of life. |
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