Wessel Lauren E, Fufa Duretti T, Boyer Martin I, Calfee Ryan P
Department of Orthopedic Surgery, Washington University in St Louis School of Medicine, St Louis, MO 63110, USA.
J Hand Surg Am. 2013 Jan;38(1):49-55. doi: 10.1016/j.jhsa.2012.08.040. Epub 2012 Nov 28.
Previous studies have identified the association between trigger digit and carpal tunnel syndrome (CTS). However, whether the presence of multiple trigger digits affects the prevalence of CTS is unknown. The purpose of this study was to determine the incidence of carpal tunnel symptoms in patients treated for single versus multiple trigger digits.
We performed a retrospective review of 300 patients treated for trigger digit by injection or surgical release and recorded CTS symptoms, signs, and treatment for either the ipsilateral or contralateral hand documented within 24 months before trigger digit treatment and for an average of 35 months (range, 7- 66 mo) after treatment. Patients were categorized as having single (n = 160) or multiple (n = 140) trigger digits. Binary logistic regression modeled risk factors for development of CTS. Patient age, sex, number of trigger digits (single or multiple), and presence of diabetes, gout, thyroid disease, or thumb osteoarthritis were considered independent variables.
A total of 58 of 140 patients (41%) who presented with multiple trigger digits exhibited concomitant carpal tunnel symptoms, compared with 26 of 160 (16%) patients who presented with a single trigger digit. Significant independent predictors of CTS associated with trigger digits in the final regression model included multiple trigger digits (odds ratio = 3.6; subjects with multiple trigger digits had significantly higher odds of carpal tunnel presentation than subjects with a single trigger digit) and diabetes (odds ratio = 1.9; diabetic subjects had significantly higher odds of carpal tunnel presentation than nondiabetics).
A greater than 3-fold increase in the relative risk of CTS development exists in patients undergoing treatment for multiple trigger digits, compared with those undergoing treatment for a single trigger digit. Awareness of this association may aid in the early diagnosis and treatment of CTS in patients presenting with multiple trigger digits.
TYPE OF STUDY/LEVEL OF EVIDENCE: Prognostic III.
既往研究已证实扳机指与腕管综合征（CTS）之间存在关联。然而，多个扳机指的存在是否会影响CTS的患病率尚不清楚。本研究的目的是确定接受单发性或多发性扳机指治疗的患者中腕管症状的发生率。
我们对300例接受注射或手术松解治疗扳机指的患者进行了回顾性研究，并记录了扳机指治疗前24个月内以及治疗后平均35个月（范围7 - 66个月）同侧或对侧手部的CTS症状、体征及治疗情况。患者被分为单发性扳机指（n = 160）或多发性扳机指（n = 140）。采用二元逻辑回归对CTS发生的危险因素进行建模。将患者年龄、性别、扳机指数量（单发或多发）以及是否患有糖尿病、痛风、甲状腺疾病或拇指骨关节炎作为自变量。
140例有多发性扳机指的患者中，共有58例（41%）出现了伴随的腕管症状，而160例有单发性扳机指的患者中，有26例（16%）出现了该症状。最终回归模型中与扳机指相关的CTS显著独立预测因素包括多发性扳机指（比值比 = 3.6；有多发性扳机指的患者出现腕管症状的几率显著高于有单发性扳机指的患者）和糖尿病（比值比 = 1.9；糖尿病患者出现腕管症状的几率显著高于非糖尿病患者）。
与接受单发性扳机指治疗的患者相比，接受多发性扳机指治疗的患者发生CTS的相对风险增加了3倍以上。认识到这种关联可能有助于对有多发性扳机指的患者进行CTS的早期诊断和治疗。
研究类型/证据水平：预后性研究III级
