Bruijnzeel Hanneke, Neuhaus Valentin, Fostvedt Sigrid, Jupiter Jesse B, Mudgal Chaitanya S, Ring David C
Orthopaedic Hand Service, Massachusetts General Hospital, Boston, MA, USA.
J Hand Surg Am. 2012 Aug;37(8):1650-6. doi: 10.1016/j.jhsa.2012.05.014. Epub 2012 Jul 3.
To classify and report adverse events of trigger finger release in a large cohort of patients.
We retrospectively reviewed 1,598 trigger finger releases performed by 12 surgeons in 984 patients between 2001 and 2011. Adverse events were classified based on a system derived from the Centers for Disease Control and Prevention criteria and clinical experience. Risk factors for various adverse events were sought in bivariate and multivariable statistical analysis.
At the latest follow-up, 66 patients (7%), or 84 operated trigger digits (5%), experienced a documented adverse event. The most common adverse events were recovery issues in 46 patients (3%) (such as postoperative symptoms treated with steroid injection or slow recovery of motion treated with hand therapy), wound problems in 30 patients (2%) (consisting of suture abscess, superficial infection, or wound separation), persistent postoperative triggering in 10 patients (0.6%), and recurrent triggering in 4 patients (0.3%). Diabetes mellitus was associated with wound problems, slow recovery of motion, and recurrence. Concomitant carpal tunnel release on the same side was associated with slow recovery.
Fourteen patients, less than 1%, in this cohort experienced an adverse event, such as persistent or recurrent triggering, requiring secondary surgery. No nerve injury or deep infection occurred in our cohort. One in 15 patients experienced a minor transient or treatable adverse event, and patients with diabetes were at greater risk.
TYPE OF STUDY/LEVEL OF EVIDENCE: Therapeutic IV.
对大量扳机指松解患者的不良事件进行分类和报告。
我们回顾性分析了2001年至2011年间12位外科医生为984例患者实施的1598例扳机指松解手术。不良事件根据源自美国疾病控制与预防中心标准及临床经验的系统进行分类。在双变量和多变量统计分析中探寻各种不良事件的风险因素。
在最近一次随访时，66例患者（7%），即84个接受手术的手指（5%）发生了记录在案的不良事件。最常见的不良事件为46例患者（3%）出现恢复问题（如用类固醇注射治疗术后症状或用手部治疗改善运动恢复缓慢），30例患者（2%）出现伤口问题（包括缝线脓肿、浅表感染或伤口裂开），10例患者（0.6%）出现术后持续扳机现象，4例患者（0.3%）出现复发性扳机现象。糖尿病与伤口问题、运动恢复缓慢及复发相关。同侧同时进行腕管松解与恢复缓慢相关。
该队列中14例患者（不到1%）发生了不良事件，如持续性或复发性扳机现象，需要二次手术。我们的队列中未发生神经损伤或深部感染。15例患者中有1例发生轻微短暂或可治疗的不良事件，糖尿病患者风险更高。
研究类型/证据水平：治疗性IV级。
