Bae Donald S, Sodha Samir, Waters Peter M
Crystal Run Healthcare, Rock Hill, NY, USA.
J Hand Surg Am. 2007 Sep;32(7):1043-7. doi: 10.1016/j.jhsa.2007.05.031.
The purpose of this investigation is to assess the efficacy of a standardized surgical technique in the treatment of symptomatic trigger fingers in pediatric patients.
A retrospective study was performed of 18 consecutive patients with 23 trigger fingers treated at our institution between 1996 and 2006. Average age at the time of presentation was 4.5 years (range, 1-12 years). Involved digits included 2 index, 12 long, 3 ring, and 6 small fingers. All patients had surgical treatment consisting of A1 pulley release and resection of a single slip of the flexor digitorum superficialis (FDS) tendon. Average clinical follow-up evaluation was 43 months (range, 3-111 months).
In almost half of the cases, triggering was noted to occur at the level of the FDS tendon decussation. In 9 cases, specific tendon pathology was observed, including fusiform thickening, nodular thickening, calcific tendonitis, and cyst formation. Overall, 21 of 23 (91%) fingers demonstrated successful resolution of triggering without recurrence after surgical treatment. One patient had recurrent triggering, which was successfully treated by a second procedure to resect the remaining FDS slip. Another patient was successfully treated with excision of an aberrant muscle belly from the FDS. Both of these patients remained asymptomatic after their revision procedures. No other complications were observed. All patients returned to full activities, and 17 of 18 (94%) patients were satisfied with the results of surgery at most recent follow-up evaluation.
The pediatric trigger finger may be safely and predictably treated by surgical release of the A1 pulley and resection of a single FDS tendon slip.
本研究旨在评估一种标准化手术技术治疗小儿症状性扳机指的疗效。
对1996年至2006年间在本机构接受治疗的18例连续患者的23根扳机指进行回顾性研究。就诊时的平均年龄为4.5岁（范围1至12岁）。受累手指包括2根示指、12根中指、3根环指和6根小指。所有患者均接受了手术治疗，包括A1滑车松解和指浅屈肌腱（FDS）单束切除。平均临床随访评估时间为43个月（范围3至111个月）。
在近一半的病例中，扳机现象出现在FDS肌腱交叉水平。9例观察到特定的肌腱病变，包括梭形增厚、结节状增厚、钙化性肌腱炎和囊肿形成。总体而言，23根手指中有21根（91%）在手术治疗后扳机现象成功消除且未复发。1例患者出现复发性扳机现象，通过再次手术切除剩余的FDS束成功治疗。另1例患者通过切除FDS上的异常肌腹成功治疗。这2例患者在翻修手术后均无症状。未观察到其他并发症。所有患者恢复了全部活动，18例患者中有17例（94%）在最近一次随访评估时对手术结果满意。
小儿扳机指通过A1滑车松解和FDS肌腱单束切除可安全、有效地治疗。
