Baumgarten Keith M, Gerlach David, Boyer Martin I
Sports Medicine and Shoulder Surgery Section, The Orthopedic Institute, 810 East 23rd Street, Sioux Falls, SD 57108, USA.
J Bone Joint Surg Am. 2007 Dec;89(12):2604-11. doi: 10.2106/JBJS.G.00230.
It is generally accepted that the initial treatment for trigger finger is injection of corticosteroid into the flexor tendon sheath. In this study, the efficacy of corticosteroid injections for the treatment of trigger finger in patients with diabetes mellitus was evaluated in a prospective, randomized, controlled, double-blinded fashion and the efficacy in nondiabetic patients was evaluated in a prospective, unblinded fashion.
Thirty diabetic patients (thirty-five digits) and twenty-nine nondiabetic patients (twenty-nine digits) were enrolled. The nondiabetic patients were given corticosteroid injections in an unblinded manner. The cohort with diabetes was randomized into a corticosteroid group (twenty digits) or a placebo group (fifteen digits). Both of these groups were double-blinded. Additional injections, surgical intervention, and recurrent symptoms of trigger finger were recorded. Treatment success was defined as complete or nearly complete resolution of trigger finger symptoms such that surgical intervention was not required.
After one or two injections, twenty-five of the twenty-nine digits in the nondiabetic group had a successful outcome compared with twelve of the nineteen in the diabetic corticosteroid group (p = 0.03) and eight of the fifteen in the diabetic placebo group (p = 0.006). With the numbers studied, no significant difference was found between the diabetic groups. Surgery was performed in three of the twenty-nine digits in the nondiabetic group compared with seven of the nineteen in the diabetic corticosteroid group and six of the fifteen in the diabetic placebo group. There was a significant difference in the prevalence of surgery between the nondiabetic group and both the diabetic corticosteroid group and the diabetic placebo group (p = 0.035 and p = 0.020, respectively). With the numbers studied, no difference was found between the diabetic groups with regard to the persistence of symptoms. Nephropathy and neuropathy were significantly associated with the need for surgery (p = 0.008 and p = 0.03, respectively).
Corticosteroid injections were significantly more effective in the digits of nondiabetic patients than in those of diabetic patients. In patients with diabetes, corticosteroid injections did not decrease the surgery rate or improve symptom relief compared with the placebo. The use of corticosteroid injections for the treatment of trigger finger may be less effective in patients with systemic manifestations of diabetes mellitus.
一般认为，扳机指的初始治疗方法是向屈肌腱鞘内注射皮质类固醇。在本研究中，以前瞻性、随机、对照、双盲方式评估皮质类固醇注射治疗糖尿病患者扳机指的疗效，并以前瞻性、非盲方式评估非糖尿病患者的疗效。
纳入30例糖尿病患者（35指）和29例非糖尿病患者（29指）。非糖尿病患者接受非盲法皮质类固醇注射。糖尿病队列被随机分为皮质类固醇组（20指）或安慰剂组（15指）。这两组均为双盲。记录额外注射、手术干预和扳机指复发症状。治疗成功定义为扳机指症状完全或几乎完全缓解，无需手术干预。
注射一或两次后，非糖尿病组29指中有25指治疗成功，而糖尿病皮质类固醇组19指中有12指（p = 0.03），糖尿病安慰剂组15指中有8指（p = 0.006）。就所研究的数量而言，糖尿病组之间未发现显著差异。非糖尿病组29指中有3指接受了手术，而糖尿病皮质类固醇组19指中有7指，糖尿病安慰剂组15指中有6指。非糖尿病组与糖尿病皮质类固醇组和糖尿病安慰剂组的手术发生率存在显著差异（分别为p = 0.035和p = 0.020）。就所研究的数量而言，糖尿病组在症状持续方面未发现差异。肾病和神经病变与手术需求显著相关（分别为p = 0.008和p = 0.03）。
皮质类固醇注射对非糖尿病患者手指的疗效明显优于糖尿病患者。在糖尿病患者中，与安慰剂相比，皮质类固醇注射并未降低手术率或改善症状缓解情况。对于有糖尿病全身表现的患者，使用皮质类固醇注射治疗扳机指可能效果较差。
