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本次文献选自Jung HS, Baek SH, Lee JS. Is a Steroid Injection in Both Compartments More Effective than an Injection in the Extensor Pollicis Brevis Subcompartment Alone in Patients with de Quervain Disease? A Randomized, Controlled Trial. Clin Orthop Relat Res. 2022,480(4):762-770. 本次学习由魏广福主治医师主讲。
Introduction
de Quervain disease is a stenosing tenosynovitis of the first extensor compartment of the wrist, which is composed of the abductor pollicis longus (APL) and extensor pollicis brevis (EPB) tendons. It can be treated with nonsurgical methods, such as limiting the use of the thumb, using a brace, injecting a corticosteroid, or, if these processes are ineffective, surgically releasing the tendon sheath of the first dorsal compartment. Among nonsurgical procedures, a steroid injection is often performed for patients with de Quervain disease, with as many as 83% of patients achieving pain relief.
引言
de Quervain病是一种发生在手腕第一伸肌室（由拇长展肌APL和拇短伸肌EPB的肌腱组成）的狭窄性腱鞘炎。其可以用非手术方法治疗，如限制拇指的使用，使用支架，注射皮质类固醇，或者如果保守治疗无效，可以通过手术松解第一背侧室的腱鞘。在非手术治疗过程中，经常对de Quervain病患者进行类固醇注射，多达83%的患者能获得疼痛缓解。
de Quervain disease has been shown to have several anatomic variations that could play an important role in response to treatment. The most relevant variation is the presence of an intracompartmental septum between the APL and EPB tendons. Septation of the first compartment has been reported in 24% to 76% of specimens in cadaver studies and was found to be higher in patients with de Quervain disease. This results in subcompartmentalization of the first compartment, which may make it diffificult for the injection to reach the entire tendon sheath effectively. Therefore, some have suggested that an injection into each subcompartment may make it more likely that injection will provide pain relief.
de Quervain病已被证明有几种解剖学上的变异，这些变异可能对治疗的反应起重要作用。最相关的变异是APL和EPB肌腱之间存在室间隔。在尸体研究中，有24%至76%的标本出现了室间隔，并且在de Quervain病患者中，室间隔的比例更高。这导致了第一室的亚室化，这可能使注射液难以有效地到达整个腱鞘。因此，有人提出，向每个亚室注射可能更有效地缓解疼痛。
Ultrasound (US) is widely used to assess musculoskeletal disorders because it is noninvasive and inexpensive and does not expose patients to radiation. Studies have reported its usefulness in the diagnosis and treatment of de Quervain disease. In de Quervain disease, the use of US for injection is an accurate method for delivering steroids into both subcompartments, and one study reported that US-guided injections showed better results than the blinded method. However, according to previous studies, the main lesion of de Quervain disease in patients with a septum is a stenosing tenosynovitis of the EPB. In anatomic studies, an intracompartmental septum was usually present at the radial styloid in the first compartment, creating a separate, narrow compartment for the EPB tendon. Furthermore, failure to inject steroids into the EPB sheath could result in persistent symptoms, just as an unreleased, separate EPB subcompartment could lead to persistent symptoms after surgery. Therefore, recent studies have focused on US-guided intrasynovial injections targeting the EPB tendon in the presence of a septum. Although previous studies have compared injections into both subcompartments with injections into a single compartment, to our knowledge, there is no report to date comparing injections into the EPB subcompartment with injections into both subcompartments.
超声（US）被广泛用于评估肌肉骨骼疾病，因为它无创且价格便宜，而且没有辐射。有研究报告超声在诊断和治疗de Quervain病方面很有意义。在de Quervain病中，使用超声引导下注射是将类固醇注入两个亚室的准确方法。一项研究报告说明，超声引导下的注射比盲法的效果更好。根据以前的研究，在有室间隔的病人中，de Quervain病的主要病变是EPB的狭窄性腱鞘炎。在解剖学研究中，室间隔内通常存在于第一室的桡骨指骨处，为EPB肌腱创造了一个单独的、狭窄的亚室。此外，未能向EPB鞘内注射类固醇可能导致症状无改善，正如未松解的、独立的EPB亚室可能导致术后症状无改善一样。因此，最近的研究集中在超声引导下的鞘内注射，目标是有隔膜的EPB肌腱。虽然以前的研究比较了向两个亚室的注射和向单一亚室的注射，但据我们所知，到目前为止还没有报告比较单独向EPB亚室的注射和同时向两个亚室的注射。
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