Soft tissue injuries
Soft tissue injuries discussed here , actually refers to acupoint injection improperly , causing damage to the muscle intrinsic hand . After the injury, scarring , resulting in hand contracture deformity. In all needle injury reports, the number of cases this damage primacy , more than 400 cases have been reported so far . There are four articles were summarized 209 cases [ 1-4 ] , found that has the following characteristics :
First, according to the survey , occurred in children aged 6 to 16 , with an average age of 9.9 to 10.9 years of such injury to children less than 12 years the most common.
Second, hand deformities generally several months or even years after the discovery, the earliest one month , there are up to five years at the latest . The longer the time of onset, the more severe the older the deformity ,
Third, the surgery more satisfactory results , the vast majority of hand function can be recovered .
The situation in this regard , first reported seen in the early sixties of the last century [ 5 ] , four decades , not only for acupuncture practitioners attention in recent years has caused serious concern over the increasing surgeon and made a variety of appropriate surgical treatment , the therapeutic effect is obtained continuously improve .
[ Reason ] injury
Generally, there are three .
First, the cause of such damage occurring point , almost all of it is due to the injection or acupuncture Hoku ‘s . Hoku , hand Yangming large intestine through the original hole , the frequency of use is quite high . It is located between the first and second metacarpal , which is among the first superficial dorsal interosseous muscle , deep to the adductor hallucis Tau . Small hand muscles and delicate ( especially in children ) , compact structure, but its function is very important. Acupuncture point injection or improper , once in the local inflammatory response caused by chemical , oozing or bleeding , can affect these two muscles, resulting in increased pressure limitations , muscle fiber necrosis , causing damage to both local contracture , causing hand dysfunction.
Second, the reason drugs acupoint injection drug misuse is another important reason. According to our statistics , due to dipyrone and compound quinine injections caused more than about 90 % of the total incidence . The rest are: chlorpromazine, cortisone acetate , vitamin B1, antipyrine , morphine, meperidine, promethazine . These drugs primarily to a greater or irritation related to inappropriate doses , however, some drugs, only point injection 0.1 ~ 0.2ml, damage can occur .
Third, the operation of the reason or acupuncture point injection , in order to seek a better sense of the gas was repeated up and down the lift and thrust or to explore different directions , etc., to stimulate rather rapid rate , can cause damage. If one case of 24 -year-old female patient , because the cold had left Hoku bit done acupuncture , local time without any discomfort. Two months later found between the left thumb and finger webbed with mild swelling and soreness. Thumb activities inconvenient. Six months later went to the hospital and found the thumb metacarpophalangeal joint outreach and extension is limited, first finger webbed deep into a palpable cord-like hard objects. Surgery was found between the first dorsal interosseous muscle deep and superficial muscles of the thumb received white scar approximately 1.5 × 1.0 × 1.0cm3. After resection, thumb abduction and extension range of passive recovery and contralateral same . Block biopsy scar confirmed scar tissue within the muscle fibers [ 5 ] . Minorities , due healer sterile concept is not strong and infection .
Clinical manifestations
A typical process Hoku acupuncture at acupoint injection or after , local redness swelling and pain , swelling gradually disappeared about a week , gradually appear outreach inconvenience and hand deformities. Time of hand deformity can range from a week to several years after injection .
Second, the main symptom of thumb adduction was like, abduction significant barriers based disease . According to the characteristics of hand deformity symptoms can generally be divided into four types , Ⅰ type is the simple thumb adduction deformity , Ⅱ type is purely radial side of the index finger , metacarpophalangeal joint flexion deformity mild , Ⅲ type of thumb adduction combined radial side of the index finger deformity , Ⅳ type of thumb adduction with subluxation of the metacarpophalangeal joint account . 4 type were significantly more dysfunction, and to Ⅰ, Ⅱ, Ⅲ type heaviest , such as holding pens , chopsticks are extremely difficult, and the most common. Some patients may also be associated with the metacarpophalangeal joint flexion or hyperextension deformity knuckles , but also with the radial side of the index finger deformity .
According to the pathological features can be divided into three types : Ⅰ type of small hand muscle contracture confined to the thumb adductor deep , resulting in closing the thumb and metacarpophalangeal joint flexion deformity ; Ⅱ type of small hand muscle contracture limited to shallow the first layer of the dorsal interosseous muscle , leading to the radial side of the index finger deformity , still with the index finger metacarpophalangeal joint flexion deformity ; Ⅲ type of the adductor muscle and the first dorsal interosseous muscle contracture occurred , both in patients with thumb adduction, metacarpophalangeal joint flexion deformity and radial side of the index finger deformity . The vast majority of patients have palpable induration streak near the adductor muscle . Long duration , thenar group have varying degrees of atrophy , some patients , due to the first charge of the wrist and metacarpophalangeal joints in the thumb adductor muscle flexion deformity under development , a long time to form pathological subluxation.
Third, the vast majority of patients with pathological examination of the parts of the muscle fiber atrophy , and mostly moderate or severe atrophy, is replaced by fibrous hyperplasia . Intimal hyperplasia , a few cases there are fiber necrosis . Lesions generally have fibrous tissue , the degree of change in the degree of muscle atrophy and fibrosis consistent .
[ Prevention ]
A carefully acupoints Hoku is common points , but infants should choose this point as little as possible . This is due to a variety of organizations among infants and young children are still developing , anatomic landmarks unclear, difficult to accurately locate acupoints , acupuncture combined with fear and crying struggled so on. Therefore, not only difficult to achieve the desired therapeutic effect, and vulnerable to accidental damage.
Second, the drug of choice to avoid irritating Hoku strong and difficult to absorb inject drugs , but can not be repeated injections . Dipyrone and compound quinine should prohibit injection, especially in pediatric patients below the age of 12 must be strictly taboo.
Third, pay attention to the operation or acupuncture point injection , the needle should not blindly seek a strong sense of the way done as gently as possible . When EA , using the following moderate intensity and slower frequency , pediatric patients unsuitable for consumption in the needle hole .
In order to avoid or mitigate hand deformity, to achieve early detection and early treatment.
[ Approach ]
First, the initial swelling after injection of local heat , which should take physical therapy, heat and other methods to promote the absorption of the drug. If the thumb dysfunction , patients should be instructed to strengthen early functional exercise . Take a passive movement and active movement combine to reduce or avoid the occurrence of hand deformities . But generally do not advocate the use of massage , or in the jaws of death Rouan and other laws to prevent aggravating injuries.
Second, when the latter has emerged intrinsic muscle caused by scar contracture deformity of hand , you need to be hand rehabilitation. Surgical principles are: the Ministry of cutting dead adductor muscle lesions or the first dorsal interosseous muscle to relieve contracture. Among them, the adult part of the muscle belly scar was restricted , and after removal of the scar , generally restore function.