Sato Junko, Ishii Yoshinori, Noguchi Hideo, Takeda Mitsuhiro
Ishii Orthopaedic and Rehabilitation Clinic, Gyoda, Saitama, Japan.
J Hand Surg Am. 2012 Oct;37(10):2012-20. doi: 10.1016/j.jhsa.2012.06.027. Epub 2012 Aug 31.
To evaluate trigger digits with sonography to determine morphological changes in the A1 pulley, flexor tendon, and volar plate in relation to the severity of triggering.
We evaluated 67 trigger digits and graded them into 1 of 4 groups. We compared the groups according to severity and to contralateral fingers, which served as controls.
The thickness of the flexor tendons under the A1 pulley was proportional to the severity of triggering. The anteroposterior thickness of the flexor tendon increased significantly among the grades exhibiting triggering regardless of the affected digit. However, in digits other than the thumb, tendon thickness increased even in the absence of active triggering. Thickening tended to be greater with finger flexion. The A1 pulley exhibited the greatest thickness and the volar plate exhibited significant thickening in the group that exhibited continuous triggering that was easily reduced with active extension (grade III).
The flexor tendon thickened significantly before patients experienced triggering except in the thumb. In the thumb, the flexor tendon and A1 pulley thickened significantly only after patients exhibited triggering. Thickening of the volar plate appears to have an important role in continuous triggering. Although most clinicians can easily determine the severity of a trigger digit by clinical examination, ultrasound might be helpful for objectively understanding the severity and response to treatment, by examining the thickness of the flexor tendon and A1 pulley. In particular, sonographic measurement of the A1 pulley might be useful in judging the progression of trigger finger severity. In cases where a Doppler signal is detected inside the A1 pulley, more conservative therapies might be worth considering before surgery.
TYPE OF STUDY/LEVEL OF EVIDENCE: Diagnostic ΙΙΙ.
通过超声评估扳机指，以确定A1滑车、屈肌腱和掌侧板的形态学变化与扳机严重程度的关系。
我们评估了67例扳机指，并将其分为4组中的1组。我们根据严重程度和作为对照的对侧手指对各组进行比较。
A1滑车下方屈肌腱的厚度与扳机严重程度成正比。无论受影响的手指如何，在出现扳机的分级中，屈肌腱的前后厚度均显著增加。然而，在拇指以外的手指中，即使在没有主动扳机的情况下，肌腱厚度也会增加。随着手指屈曲，增厚往往更明显。在表现为持续扳机且主动伸展时易于复位的组（III级）中，A1滑车厚度最大，掌侧板显著增厚。
除拇指外，患者出现扳机前屈肌腱明显增厚。在拇指中，只有在患者出现扳机后，屈肌腱和A1滑车才会明显增厚。掌侧板增厚似乎在持续扳击中起重要作用。尽管大多数临床医生可以通过临床检查轻松确定扳机指的严重程度，但超声检查屈肌腱和A1滑车的厚度可能有助于客观地了解严重程度和对治疗的反应。特别是，A1滑车的超声测量可能有助于判断扳机指严重程度的进展。在A1滑车内部检测到多普勒信号的情况下，在手术前可能值得考虑更保守的治疗方法。
研究类型/证据水平：诊断性III级。
