Will Ryan, Lubahn John
Department of Orthopaedic Surgery, Hamot Medical Center, Erie, PA, USA.
J Hand Surg Am. 2010 Apr;35(4):594-6. doi: 10.1016/j.jhsa.2009.12.040. Epub 2010 Feb 26.
Open release of A1 pulleys for trigger finger has been thought of as a relatively benign procedure with a low complication rate. Few studies have examined the rate of complications in trigger finger release. The objective of this study was to retrospectively review the complications documented for a cohort of patients who received open trigger finger releases.
We conducted a retrospective chart review of 43 patients who had had 78 open trigger finger releases by a single surgeon. Any postoperative complications that were documented were recorded. Complications were then divided into major and minor. Major complications required further surgery or resulted in significant limitations of activities of daily living; minor complications hindered recovery, responded to treatment (if applicable), and either resolved or had little impact on function.
Two major complications were noted: a synovial fistula that required excision, and proximal interphalangeal joint arthrofibrosis that required cast application for pain relief. The major complication rate was 3% per trigger release (2/78). Twenty-seven minor complications in 22 digits were documented for these cases, including decreased range of motion, scar tenderness, pain, and wound erythema. The minor complication rate was 28% (22/78). The overall, combined complication rate for these primary interventions was 31% (24/78).
Open trigger finger release is thought to be a low-risk procedure by most practitioners. In this study, we found that major complications do occur infrequently; however, the rate of minor complications was surprisingly high and related mostly to wound complications or loss of finger range of motion. The surgeon performing open trigger finger releases should inform the patient of the likelihood of having these minor complications.
扳机指的A1滑车开放松解术被认为是一种相对良性的手术,并发症发生率较低。很少有研究探讨扳机指松解术的并发症发生率。本研究的目的是回顾性分析一组接受扳机指开放松解术患者的并发症记录。
我们对一位外科医生为43例患者进行的78次扳机指开放松解术进行了回顾性病历审查。记录所有记录在案的术后并发症。并发症随后分为严重和轻微两类。严重并发症需要进一步手术或导致日常生活活动严重受限;轻微并发症妨碍恢复,对治疗有反应(如适用),且要么得到解决,要么对功能影响很小。
发现了两种严重并发症:一例滑膜瘘需要切除,一例近端指间关节纤维性关节病需要使用石膏来缓解疼痛。每次扳机指松解术的严重并发症发生率为3%(2/78)。这些病例记录了22个手指出现的27例轻微并发症,包括活动范围减小、瘢痕压痛、疼痛和伤口红斑。轻微并发症发生率为28%(22/78)。这些初次干预的总体并发症发生率为31%(24/78)。
大多数从业者认为扳机指开放松解术是一种低风险手术。在本研究中,我们发现严重并发症确实很少发生;然而,轻微并发症的发生率惊人地高,且大多与伤口并发症或手指活动范围丧失有关。实施扳机指开放松解术的外科医生应告知患者发生这些轻微并发症的可能性。