1.Efficacy observation 1.1 Efficacy evaluation criteria
According to the evaluation criteria established by the State Administration of Traditional Chinese Medicine [2]: cured, no pain on the palm side of the affected finger, no local pressure pain, normal finger flexion and extension activities, no popping and interlocking phenomenon; improved, local swelling and pain reduced, slight pain when the affected finger moves, or mild popping, but no interlocking phenomenon; not cured, no change in clinical symptoms. Treatment was carried out by regular follow-up visits by outpatient appointments, letter visits or telephone follow-up visits. The follow-up time ranged from 3 to 10 months, with an average of 6 months. 1.2 Treatment results: The treatment time was 1 to 3 weeks. 63 cases (92 fingers) in this group were evaluated according to the above criteria, 45 cases were cured, 13 cases were apparently effective, 3 cases were effective, and 2 cases were ineffective, with an overall effective rate of 96.8%. 2, discussion 2.1 causes of flexor tendon stenosis tendovaginitis (1) chronic strain: long-term repeated excessive flexion and extension activities of the metacarpophalangeal joint, so that the deep and shallow flexor tendons rub against each other, or long-term hand-held tools, fiber sheath tube by hard objects and palm bone extrusion, resulting in aseptic inflammation of the tendon and tendon sheath, especially in dumpling workers, nursing women. (2) Anatomical factors: the lesion is likely to occur at the beginning of the fiber sheath canal of the flexor tendon corresponding to the metacarpal head. The long flexor tendon of the thumb also passes between the seed bone at the base of the first phalanx and the deep and superficial head of the short flexor of the thumb, so the incidence is highest especially in the thumb. (3) degenerative factors: with the increase of age, their hand activities also gradually reduced, and suddenly some repeated and frequent finger flexion and extension activities, resulting in its local tendon sheath within the congestion edema caused, especially in the 40 to 60 years of age between the middle and old age women are more common. 2.2 The pathological changes of stenosing tenosynovitis repeated frequent or excessive activities, so that the lesion of the fiber sheath local congestion, edema, early or improper treatment followed by fibrosis, thickening of the sheath, the formation of the lumen of the ring narrowing, and even cartilage degeneration and calcification of the sheath, the lesion of the tendon after long-term pressure is gourd-shaped or shuttle-shaped expansion, dark yellow, loss of the original luster. Due to the lack of understanding of the prevention or treatment of tenosynovitis in most patients, most patients still and increase their finger flexion and extension activities after the onset of the disease, resulting in the friction between the tendon and the tendon sheath carriage aggravates the pain and local inflammatory reaction, which further aggravates the tendon sheath stenosis, forming a vicious circle. When the enlarged tendon is embedded by the narrow tendon sheath, active flexion and extension are not possible, but passive flexion and extension are sometimes possible, and even “hook-like” deformity may occur. 2.3 Treatment principle
Tenosynovitis of flexor tendon stenosis, according to Chinese medicine, this disease belongs to the scope of “paralysis”. Mostly due to strain, wind, cold and dampness obstruction, paralysis and blockage, not pass, then pain. The women do more meticulous work, more finger activities, hands often immersed in water and moisture, water and moisture invasion, obstructing the flow of qi and blood, paralysis and onset. The fumigation of Chinese herbal formula of Sumac, Salvia, Safflower, Boswellia, Myrrh, Qiangwu, Weilingxian, Wujiapi, etc. can activate blood circulation, remove blood stasis and relieve pain; fumigation can increase local tissue temperature, capillary expansion, blood circulation, increase local blood flow and nutrition, remove metabolic stasis products, warm up venous stagnation. At the same time, the drug acts directly on the affected area to dispel wind and dampness, warm the meridian and disperse cold, pass through the meridian and relieve pain, so that local inflammation and blood stasis are absorbed, swelling subsides and pain is relieved. The fumigation, together with proper functional activities of the affected fingers and local treatment with Pingle Zhanji Dan and massage can also promote local qi and blood circulation and accelerate blood circulation, thus improving the therapeutic effect. 2.4 Analysis of therapeutic effect
From the pathological changes analyzed above, it is obvious that the pathological changes of stenosing tenosynovitis stage I are the stage of sterile inflammation produced by local congestion and edema of the fibrous sheath canal and increased exudation of its surrounding tissues. Chinese medicine fumigation facilitates local treatment, and the drugs can directly reach the affected area through the skin orifices and acupuncture points by fumigation, which has quick effect. Our clinical practice shows that the efficacy of external lavage in the treatment of stage I flexor tendon stenosis tenosynovitis is reliable, easy and safe to operate, economical, and worth promoting.