Lee S K, Bae K W, Choy W S
Department of Orthopedic Surgery, Eulji University College of Medicine, Daejeon, South Korea
Department of Orthopedic Surgery, Eulji University College of Medicine, Daejeon, South Korea.
J Hand Surg Eur Vol. 2014 Sep;39(7):694-8. doi: 10.1177/1753193413479506. Epub 2013 Feb 26.
It has been suggested that the increased frequency of trigger finger (TF) after carpal tunnel release (CTR) may be caused by the volar migration of the flexor tendons at the wrist altering the tendon biomechanics at the A1 pulley. This hypothesis has not been validated. We performed pre- and post-operative ultrasonography (USG) on the affected wrists of 92 patients who underwent CTR. Pre-operative USG was performed in neutral with no tendon loading; post-operative USG was performed in neutral unloaded and in various positions of wrist flexion whilst loading the flexor tendons with gripping. The mean volar migration of the flexor tendons after CTR was 2.2 (SD 0.4) mm in the unloaded neutral position. It was 1.8 (SD 0.4) mm in patients who did not develop TF and 2.5 (SD 0.5) mm in those who did (p = 0.0067). In loaded wrist flexion, the mean volar migration of flexor tendons after CTR in patients who did not develop TF and those who did was 2.1 and 3.0 mm in 0° flexion; 3.2 and 3.9 mm in 15° flexion; 4.3 and 5.1 mm in 30° flexion; and 4.9 and 5.8 mm in 45° flexion, respectively. There were significant differences between patients with and without TF at each flexion angle. Our data indicate that patients with greater volar migration of the flexor tendons after CTR are more likely to develop TF. This conclusion supports the hypothesis that the occurrence of TF after CTR may be caused by the bowstringing effects of the flexor tendons.
有人提出，腕管松解术（CTR）后扳机指（TF）发病率增加可能是由于腕部屈肌腱向掌侧移位，改变了A1滑车处的肌腱生物力学。这一假设尚未得到验证。我们对92例行CTR的患者患侧手腕进行了术前和术后超声检查（USG）。术前USG在中立位且无肌腱负荷时进行；术后USG在中立位无负荷以及在腕部不同屈曲位同时通过抓握加载屈肌腱时进行。CTR后屈肌腱在无负荷中立位的平均掌侧移位为2.2（标准差0.4）mm。未发生TF的患者为1.8（标准差0.4）mm，发生TF的患者为2.5（标准差0.5）mm（p = 0.0067）。在加载腕部屈曲时，未发生TF的患者和发生TF的患者CTR后屈肌腱的平均掌侧移位在0°屈曲时分别为2.1和3.0 mm；在15°屈曲时为3.2和3.9 mm；在30°屈曲时为4.3和5.1 mm；在45°屈曲时为4.9和5.8 mm。在每个屈曲角度，发生TF和未发生TF的患者之间存在显著差异。我们的数据表明，CTR后屈肌腱掌侧移位较大的患者更有可能发生TF。这一结论支持了CTR后TF的发生可能是由屈肌腱弓弦效应引起的这一假设。
