But the application prospect may be limited.

Let's take a look at the possible problems:

1. Will this news report make patients mistakenly think that all tenosynovitis patients are suitable for this convenient minimally invasive surgery? According to the news description, Dr. Zeng gave himself 1 muscle septum release, that is, cut the diaphragm between abductor pollicis longus and extensor pollicis brevis to release the muscle septum of 1 extensor pollicis dorsi. This report highlights the characteristics of the operation: single operation, emergency room environment, 3mm incision, 3 minutes to complete, and the operation was smooth. Literally, it will give people a feeling that the operation is very simple, cheap, quick recovery and no sequelae. But most people will ignore several points: the tendon sheath of styloid process of radius is shallow, which can be seen by cutting the skin; 3mm incision, to be honest, I am a young man who can't even see clearly under the microscope.

Tendon sheath of styloid process of radius

How to change the flexor tendon sheath of the other finger?

Of course, it is not impossible, but nerves and small blood vessels are distributed around the flexor tendon sheath of most fingers. It's obviously not that easy to avoid injury as much as possible. Therefore, we need to consider whether this news will mislead some patients.

Tendon sheath of finger

2. Is there a better surgical method? Surgical treatment can fundamentally solve tendon sheath stenosis, so it can quickly relieve pain and restore function. For refractory tenosynovitis of radial styloid process, surgical treatment should be considered. Surgical methods for tenosynovitis of radial styloid process include the following.

① Direct open surgery: The conventional surgical method is to cut directly at the tender place, expose 1 dorsal myofascial compartment, cut the thickened tendon sheath, and release the tendon sheath, with the tendon sliding freely in the tendon sheath as the standard. Its advantages are rapid response; The disadvantage is that tendon dislocation may occur after the retinaculum is removed, and there is a risk of infection. In recent years, the concept of minimally invasive has prevailed and will inevitably be eliminated in the future; ② 1 myofascial compartment release: instead of cutting off the thickened tendon sheath, the tendon sheath cyst found in 1 extensor pollicis brevis compartment was removed or the diaphragm between abductor pollicis longus and extensor pollicis brevis was cut off to release 1 myofascial compartment of extensor dorsi. The advantages are that 1 extensor dorsi muscle septum is protected and tendon is relatively stable; The disadvantage is that if the thickened tendon sheath is not removed, there may still be inflammation and edema in the thickened tendon sheath, which will lead to disease recurrence due to friction with tendon; ③ Percutaneous release with small needle knife: the small needle knife cuts off the tendon sheath at the compression site through minimally invasive closure, relieving the compression and relieving the symptoms of patients. However, blindly cutting the tendon sheath is easy to cause complications such as tendon rupture and neurovascular injury, and it is best to operate under ultrasound-assisted precise positioning. The advantages are small pinhole, complete release, safety and reliability, no additional injury, no damage to peripheral blood vessels and nerves, very satisfactory immediate treatment effect and low recurrence rate after long-term observation.

④ Arthroscopic enlargement of bone fiber tube: after incision, it was separated into tendon, and the bone fiber tube was inserted under arthroscope, and the swollen sheath and accessory scar tissue in the bone fiber tube were fully scraped off and sucked out of the body. It has the advantages of less trauma, short course of treatment, quick recovery and no tendon dislocation. The disadvantage is that it is expensive and has no obvious advantage compared with open surgery; Therefore, from the operational point of view, it may be better to release the needle knife through the skin. However, to sum up, open solutions and relaxed solutions under micromanipulation can also be considered.

3. Does emergency room surgery increase the chance of bacterial infection? The regular operating room has an efficient and safe air purification system, and the air delivered by it will be filtered to ensure the sterile environment of the operating room. The emergency room is similar to the consulting room, and the cleanliness is very different from that of the operating room. Although the operation incision is small and the operation time is short, if there are special circumstances, the operation is more difficult and takes a little longer. Can bacteria in the air pollute surgical wounds and surgical instruments? It is worth thinking about.

Superficial lesions can be carried out in outpatient operating room for a long time, but the tendon sheath that affects the fine movement of human hands is of great significance. If bacterial infection occurs, it will lead to tissue adhesion, and the consequences will be unimaginable, and the hand may be wasted. This is also the reason why aseptic inflammation such as hand fracture and tendon sheath needs to be treated in a strictly sterilized operating room.

However, from its original intention of exploring minimally invasive, it is still worthy of being accepted by the public. However, in terms of surgical indications and surgical methods, the practical significance of this convenient and quick surgical method described in this paper may not be as great as imagined.