Marek Daniel J, Fitoussi Franck, Bohn Deborah C, Van Heest Ann E
Department of Orthopaedic Surgery, University of Minnesota, Minneapolis, MN 55454, USA.
J Hand Surg Am. 2011 Apr;36(4):647-652.e2. doi: 10.1016/j.jhsa.2011.01.011.
The spontaneous recovery rate for locked pediatric trigger thumb (PTT) has recently been reported at between 24% and 66%; these studies concluded that a conservative approach for this condition could be adopted. The aims of this study were to review our results of surgical release of the PTT and to survey pediatric hand surgeons regarding their practice patterns for treatment of the PTT.
After institutional review board approval, we retrospectively reviewed 173 consecutive patients with 217 thumbs treated surgically at our institution. An e-mail survey of 27 pediatric hand surgeons questioned treatment of a 2-year-old child with a 6-month history of a locked trigger thumb and of an intermittently triggering thumb.
The retrospective review demonstrated that preoperative range of motion averaged 36° loss of extension (range, 0° to 90°; SD, 22°); postoperative range of motion averaged 1° loss of extension (range, 0° to 30°; SD, 7°) at 27-day follow-up. Using a parent questionnaire at an average follow-up of 4.2 years, there were no major complications or recurrences identified. Five thumbs developed minor skin complications that healed with conservative management. There were no secondary surgeries. The practice pattern survey demonstrated that 85% of pediatric hand surgeons would treat a locked PTT in a 2-year-old with surgical release and 52% would treat an intermittently triggering thumb in a 2-year-old with continued observation if the triggering thumb was not painful.
The surgical results reported in this study, along with the practice pattern survey, confirm that surgical release is a short, safe, and effective procedure when performed by specialty trained hand surgeons, and it is the treatment of choice for a locked PTT.
最近报道的小儿扳机指（PTT）自发恢复率在24%至66%之间；这些研究得出结论，对于这种情况可以采用保守治疗方法。本研究的目的是回顾我们小儿扳机指手术松解的结果，并就小儿手外科医生治疗小儿扳机指的实践模式进行调查。
经机构审查委员会批准后，我们回顾性分析了在我们机构接受手术治疗的173例连续患者的217根拇指。通过电子邮件对27位小儿手外科医生进行调查，询问他们对一名有6个月扳机指锁定病史的2岁儿童以及一名间歇性扳机指儿童的治疗情况。
回顾性分析表明，在术后27天随访时，术前平均伸展活动度丧失36°（范围为0°至90°；标准差为22°）；术后平均伸展活动度丧失1°（范围为0°至30°；标准差为7°）。在平均4.2年的随访中使用家长调查问卷，未发现重大并发症或复发情况。有5根拇指出现轻微皮肤并发症，经保守治疗后愈合。未进行二次手术。实践模式调查表明，85%的小儿手外科医生会对一名2岁的扳机指锁定患儿进行手术松解治疗，52%的医生会对一名2岁的间歇性扳机指患儿在扳机指不疼痛时继续观察。
本研究报告的手术结果以及实践模式调查证实，由经过专业培训的手外科医生进行手术松解是一种简短、安全且有效的手术，是扳机指锁定的首选治疗方法。
