Department of Orthopaedics, Chiayi Christian Hospital, Chiayi, Taiwan.
Ultrasound Med Biol. 2013 Jun;39(6):967-74. doi: 10.1016/j.ultrasmedbio.2013.01.005. Epub 2013 Apr 3.
Trigger digit is recognized as thickening and constriction of the flexor tendon sheath at the base of digits. This study investigates the correlation between the severity grading of trigger digits and clinical findings from high-frequency ultrasonography. We measured and compared thicknesses, areas and pathological changes of the flexor digit tendons among total, contracture and noncontracture trigger digits and noninvolved contralateral digits. Forty-seven patients with 55 idiopathic trigger digits (36 contracture and 19 noncontracture) and 55 noninvolved contralateral digits were examined using high-frequency ultrasonography. The thickness of the flexor tendons was measured in a longitudinal plane at the A1 pulley: Inlet (metacarpal head-neck junction), Outlet (proximal phalangeal base-shaft junction) and Interpulley (middle of Inlet and Outlet). The cross-sectional and extratendinous tissue areas of the flexor tendons in a transverse plane at the point of Interpulley were measured. Pathological changes including irregular internal echotextures, fluid collection, dominant A1 pulley and abnormal metacarpophalangeal joint were analyzed. All thicknesses and areas of total and contracture trigger digits were significantly greater than those of noninvolved contralateral digits (p < 0.05), whereas no significant difference was observed in noncontracture trigger digits. The pathological changes were all significantly different from noninvolved contralateral digits in total, contracture and noncontracture trigger digits (p < 0.05). In contracture and noncontracture trigger digits, there were significant differences only in the thickness of the Inlet and the pathological change of the dominant A1 pulley (p < 0.05). In conclusion, the results of the ultrasonographic measurements and findings provided evidence of Notta's node and correlated with clinical findings and severity grades.
触发指被认为是手指屈肌腱鞘在指根部的增厚和狭窄。本研究调查了触发指严重程度分级与高频超声临床发现之间的相关性。我们测量并比较了总触发指、挛缩触发指和非挛缩触发指以及未受累对侧指的屈指肌腱厚度、面积和病理变化。使用高频超声检查了 47 名患有 55 个特发性触发指（36 个挛缩和 19 个非挛缩）和 55 个未受累对侧指的患者。在 A1 滑车的纵切面测量屈肌腱的厚度：入口（掌骨头颈交界处）、出口（近节指骨基底-骨干交界处）和滑车内（入口和出口的中点）。在滑车内点的横切面测量屈肌腱的横截面积和腱外组织面积。分析包括不规则内部回声纹理、积液、优势 A1 滑车和异常掌指关节在内的病理变化。总触发指和挛缩触发指的所有厚度和面积均显著大于未受累对侧指（p < 0.05），而非挛缩触发指则无显著差异。总触发指、挛缩触发指和非挛缩触发指的所有病理变化均与未受累对侧指显著不同（p < 0.05）。在挛缩和非挛缩触发指中，仅在入口厚度和优势 A1 滑车的病理变化方面存在显著差异（p < 0.05）。总之，超声测量和发现的结果提供了 Notta 结的证据，并与临床发现和严重程度分级相关。
