以高頻超音波檢查比較兩側手腕第一間隔區的變異情形：先遣研究

A Preliminary Survey of Bilateral Wrist First Compartments Variations by High Resolution Ultrasonography

根據文獻，手腕伸肌處第一間隔區隔膜的存在是造成狄魁文氏症候群的危險因子之一。若要進一步研究第一間隔區縱隔的解剖變異以及狄魁文氏症候群的關係，首先應該需要知道一般人手腕伸肌第一區間的變異盛行率。過去盛行率的研究多使用屍體解剖的研究，並且過去文獻很少比較同一個體兩側手腕伸肌第一區間的變異情形。本研究邀請任何原因需要接受超音波檢查的病患，額外接受兩側超音波檢查，並依Kwon學者研究的超音波檢測標準，進行第一間隔區隔膜解剖變異的超音波研究。結果共有24位個案、48個手腕，第一間隔區隔膜存在的盛行率為70.8%，而兩側手腕同時存在隔膜的盛行率為54.2%，並且有4位個案左右手腕第一間隔區的縱隔存在是不對稱的。根據本研究，手腕伸肌第一間隔區的變異率頗高。並且因兩側手腕同時存在隔膜的高盛行率，我們建議任何狄魁文氏症候都應該評估是否有這種變異存在並作正確的衛教，以避免狄魁文氏症候患者的患側手因休息而加重非患側手的負擔，而導致續發非患側手的狄魁文氏症候。

Back ground and purpose: The existence of the septum within the firstcompart-ment of wrists may be a risk factor of developing de Quervain’s disorder. In order to figureout the relationship between the variations in the firs compartment and de Quervain’s dis-ease, the prime question is the prevalence of normal variations in normal population. Previous studies of the prevalence were mostly based on the studies of cadava anatomy. Fur-thermore, few studies have been conducted to compare bilateral wrist variations. This study aims to investigate the anatomic variations and bilateral wrist firstcompartments variation by ultrasonography. Methods: A cross-sectional study was conducted by using the ultrasound to identify the existence of the septum within the firstextensor compartment in the wrists. To ensure all kinds of wrist anatomic variations, 24 participants (12 male, 12 female) with and without DQ was recruited. We used the criteria of Kwon’s research to detect the presence of a septum in the firstextensor compartment. Results: Among the 24 participants, the preva-lence of the septum within the firstextensor compartment was 70.8% and the prevalence of bilateral septum was 54.2%. There was a discrepancy in the firstextensor compartment be-tween the bilateral wrists in 4 participants; the prevalence rate was 16.7%. Conclusions: Ultrasonographic examination is a good way to detect the existence of septum between APL and EPB. The prevalence rate of septum was high in this study. Compared with previous re-search, the existence of septum was the risk factor of de Duervain’s disease and further evaluating the anatomic variations was warranted among those patients due to the variation of bilateral wrists. Furthermore, due to the high prevalence of bilateral septum, home educa-tion of reducing the work loading of affected wrist with subsequently increasing the burden of the unaffected wrist might be a risk factor of subsequent DQ attack in the unaffected wrists. Therefore we suggested that bilateral wrists ultrasonographic examination of DQ pa-tients should be taken subsequent DQ attack of the unaffected wrists.