| [Background]In recent years,the clinical efficacy of acupotomy in the treatment of De Quervain’ s Disease has been widely reported,but the conventional operation relies on the anatomical blind operation method,and there are still operational difficulties and risks.The ultrasound-guided acupotomy visualization operation can enhance the safety and effectiveness.However,the ultrasound-guided operation is still in the stage of experience and practice,so it needs to be combined with anatomical research for evaluation and demonstration.[Objectives]To simulate the operation of De Quervain’s Disease by ultrasound-guided acupotomy on human specimens by clinical anatomy,and compare the safety and accuracy with non-ultrasound-guided acupotomy treatment.Observe the anatomical structure of the styloid process of the radius,provide anatomic basis for the treatment of De Quervain’s Disease with acupotomy.[Methods]A total of 59 adult forearm specimens with 10%formalin-preserved were obtained.The specimens were collected from the Donation Center of Peking University School of Basic Medicine.The research period was from November 2017 to May 2018.Twenty-three specimens(U group)had higher water content with the clear ultrasound image.The ultrasound-guided method was used to release the extensor retinaculum over the first dorsal compartment,and the other 36 specimens(C group)contained Ultrasonic exploration in difficult with low water volume,and the non-ultrasound-guided acupotomy release the extensor retinaculum over the first dorsal compartment.After the acupotomy release operation was completed,the styloid process of the radius was exposed,and the acupotomy and surrounding anatomical structures were observed and compared with the ultrasound image.(1)Perform operational safety assessments for the U and C groups,and compare the safety indicators of the two groups.The safety indicators are as follows:The superficial branch of the radial nerve,use the electronic vernier caliper to measure the shortest lateral distance of the releasing incision from the superficial branch of the radial nerve(L1),and the shortest lateral direction of the superficial branch of the radial branch(L2).The shortest longitudinal distance of the loosening incision from the superficial branch of the radial nerve(L3),and whether there is a cut trace in the superficial branch of the radial nerve by the naked eye.The radial artery,the shortest lateral distance from the radial artery is measured.(L4)and the shortest longitudinal distance of the incision from the radial artery snuff pocket(L5),and visually observe whether there is a cutting mark in the radial artery.The tendon,visually observes and evaluate the presence of tendon injury.The nerve,blood vessel and tendon injury rates were calculated separately.(2)Accuracy evaluation:visually observe whether the incision of the acupotomy is located outside of the extensor retinaculum over the first dorsal compartment;use the electronic vernier caliper to measure the length of the acupotomy push mark(L6)And calculate the release success rate.(3)Using an electronic vernier caliper to measure the length of the following anatomical structure and the distance:the length of the first extensor chamber bony fiber tube(L6),the first extensor chamber bony fiber tube from the distal wrist transverse line Distance(L7);length of the iliac crest of the radius(L8);length from the distal side of the iliac crest to the distal side of the first extensor chamber(L9),the length of the proximal side of the iliac crest to the proximal side of the first extensor chamber(L10).The angle of the tendon at the styloid process of the radius(A1);whether there is a ventricular septum and its length(L11),whether there is a bony protrusion,and its size in the bony sulcus,the length(L12)width(L13)of the bone protrusion was measured(L14).[Results]The high-frequency ultrasound probe can better display the anatomy of the styloid process.(1)Safety:In the U group,L1 was 5.16±1.61mm(2.54～8.09mm),L2 was 6.59±1.75mm(3.35～9.59mm),L3 was 14.28±5.70mm(6.09～26.86mm),no obvious The superficial branch of the radial nerve was damaged.There were 3 cases of scratches on the surface of the tendon that was slightly damaged.L4 was 9.85±2.46mm(4.73 to 15.85 mm),and L5 was 8.77±2.61 mm(3.98 to 13.28mm).No radial artery injury was found.In the U group,the L1 was 5.29±1.21mm(2.93～8.05mm),the L2 was 6.25±2.20mm(2.66～11.55mm),and the L3 was 15.07±5.11mm(6.31～27.74mm).There was no obvious damage to the superficial peroneal nerve.There were 8 cases with slight scratches on the surface of the tendon.L4 was 10.43±2.15mm(6.60～15.16mm),and L5 was 8.48±3.34mm(3.36～15.48mm).No radial artery injury was found.L1,L2,L3,L4,and L5 were compared between the two groups,P>0.05,and the difference was not statistically significant.The rate of tendon injury was compared between the two groups.The U group was 13.04%,the C group was 22.22%,and the U group was lower than the C group,but the two were significantly p=0.377>0.05.Therefore,no significant difference was found between the two groups.(2)Accuracy:20 cases in the U group were successfully released,and the needles were located in the styloid process of the first extensor chamber.No horizontal deviation was observed.3 cases failed to release,2 cases of the there with needles just into the superficial fascia,which failed to release the first bony fiber sheath,and 1 case was inserted into the tendon sheath area.In group T,27 cases were successfully released,and 9 cases failed,including 1 case of longitudinal deviation.4 cases were treated with an acupotomy in the tendon sheath on the surface of the tendon sheath,and 4 cases showed no incision on the surface of the tendon sheath.The success rate of the U group was 87%,the success rate of the C group was 75%,and the success rate of the U group was high with the C group,but the two were significant p=0.266>0.05.Therefore,no significant difference was found between the two.The length of the incision in the U group was 6.87±3.91mm(0～13.99mm),and the length of the C group was 6.16±3.60mm(0～12.52mm),P>0.05.The difference was not statistically significant.(3)Anatomical measurements:L6 is 23.23±3.01mm(18.16～30.75mm),L7 is 5.76±5.16mm(0～16.26mm),L8 is 9.65±1.67mm(6.23～15.70mm),L9 is 6.78±4.59mm(0～17.96mm),L10 is 9.16±4.27mm(2.49～23.22mm).According to the distance between the fiber sheath from the radial styloid process to the distal wrist transverse line,it can be divided into type Ⅰ 35.59%(21/59):the first extensor chamber bony fiber tube extends to the distal wrist transverse line.Type Ⅱ 47.46%(28/59):the first extensor chamber bony fiber tube extends to the distal wrist transverse line between the sacral styloid;type Ⅲ 16.95%(10/59):the first extensor chamber bony fiber tube extends to the sacral styloid process.The tendon was inclined at the styloid process of the radius,and the angle A1 was 15.33±4.02°(10～25°).32.20%(19/59)of the specimens had a ventricular septum,6cases had complete length with the extension of the entire tendon,and 13 cases had incomplete ventricular septal length L11 of 6.78±2.91 mm(2.45～10.88 mm).Only 3.39%(2/59)of the acupotomy operation simultaneously released the two chamber spaces,and the length of the loose acupotomy marks was 3.62 mm and 5.32 mm,respectively.Twelve of the 40 specimens had bony prominences in the sulcus,and the incidence of bony prominence was 30%.[Conclusion]Ultrasound-guide can better identify the structure of the styloid process of the radius,reduce the damage to the tendon during operation,and also have certain advantages in identifying anatomical variations,which can improve the safety of acupotomy treatment.The two operations all have a good success rate for release the extensor retinaculum over the first dorsal compartment.The success rate of ultrasound guidance is higher than the non-ultrasound guidance mode.The ultrasound guidance method can observe the needle’trajectory and anatomy structure in real time.It is more suitable for clinical beginners.The chamber septum and the bony prominence in styloid process of radius can increase the incidence and the difficulty of treatment.The angle of the abductor longus and the extensor tendon should be observed at the styloid process of radius to reduce damage during operation. |
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