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先天性双侧扳机指延迟病例：一例报告并文献复习

Delayed Case of Congenital Bilateral Trigger Thumb: A Case Report and Review of Literature.

作者信息

Rekha Y Bhanu

机构信息

Department of Orthopaedics, Dr. Pinnamaneni Siddhartha Institute of Medical Sciences - Research Foundation Chinoutpally, Gannavaram. Andhra Pradesh. India.

出版信息

J Orthop Case Rep. 2014 Jan-Mar;4(1):24-7. doi: 10.13107/jocr.2250-0685.143.

DOI:10.13107/jocr.2250-0685.143
PMID:27298940
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC4722562/
Abstract

INTRODUCTION

Congenital trigger thumb is an uncommon anomaly of children. Its management is controversial, ranging from observation to extensive surgical release. We report a case of delayed presentation of bilateral trigger thumb along with a brief review of past literature.

CASE REPORT

A six year old girl presented with fixed flexion deformity of interphalangeal joints of both thumbs and Notta's nodules. It is diagnosed as trigger thumb and release of bilateral A1pulleys is done. But we found another constricting annular pulley just distal to A1. Only after splitting the distal pulley, we could get complete extension of interphalangeal joints. At two years follow-up, the child is free of complications.

CONCLUSION

Splitting of A1 pulley alone may not be sufficient in few cases of trigger thumb which may require distal release too.

摘要

引言

先天性扳机指是儿童中一种罕见的异常情况。其治疗存在争议，从观察到广泛的手术松解不等。我们报告一例双侧扳机指延迟就诊的病例，并对既往文献进行简要回顾。

病例报告

一名6岁女孩，双侧拇指指间关节呈固定屈曲畸形并伴有诺塔结节。诊断为扳机指，并进行了双侧A1滑车松解术。但我们发现在A1滑车远侧还有另一个狭窄的环形滑车。只有在劈开远侧滑车后，我们才能使指间关节完全伸直。随访两年，患儿无并发症。

结论

在少数扳机指病例中，仅劈开A1滑车可能并不足够，可能还需要进行远侧松解。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/47fa/4722562/558f39bf1e42/JOCR-4-24-g003.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/47fa/4722562/151ec69fcbf9/JOCR-4-24-g001.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/47fa/4722562/a668810f417e/JOCR-4-24-g002.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/47fa/4722562/558f39bf1e42/JOCR-4-24-g003.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/47fa/4722562/151ec69fcbf9/JOCR-4-24-g001.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/47fa/4722562/a668810f417e/JOCR-4-24-g002.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/47fa/4722562/558f39bf1e42/JOCR-4-24-g003.jpg

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本文引用的文献

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Varied anatomy of the thumb pulley system: implications for successful trigger thumb release.拇指滑车系统的解剖结构多样：对成功进行扳机指松解术的影响。
J Hand Surg Am. 2012 Nov;37(11):2278-85. doi: 10.1016/j.jhsa.2012.08.005.
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Conservative treatment of pediatric trigger thumb: follow-up for over 4 years.小儿扳机指的保守治疗：4年以上随访
J Hand Surg Eur Vol. 2012 Mar;37(3):220-4. doi: 10.1177/1753193411422333. Epub 2011 Oct 14.
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Trigger thumbs in children: results of surgical release.儿童扳机指：手术松解的结果。
Hong Kong Med J. 2011 Oct;17(5):372-5.
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Pediatric trigger thumb in identical twins: congenital or acquired?同卵双胞胎中的小儿扳机指：先天性还是后天性？
Orthopedics. 2010 Mar;33(3). doi: 10.3928/01477447-20100129-33. Epub 2010 Mar 10.
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Surgical treatment of pediatric trigger thumb with metacarpophalangeal hyperextension laxity.伴有掌指关节过伸松弛的小儿扳机指的手术治疗
Hand (N Y). 2009 Dec;4(4):380-4. doi: 10.1007/s11552-009-9221-8. Epub 2009 Sep 1.
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The natural history of pediatric trigger thumb.小儿扳机指的自然病史。
J Bone Joint Surg Am. 2008 May;90(5):980-5. doi: 10.2106/JBJS.G.00296.
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The congenital trigger thumb: is release of the first annular pulley alone sufficient to resolve the triggering?先天性扳机指：仅松解第一环状滑车足以解决扳机现象吗？
Ann Plast Surg. 2007 Mar;58(3):335-7. doi: 10.1097/01.sap.0000238336.30617.72.
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Extension splint for trigger thumb in children.儿童扳机指的伸展夹板
J Pediatr Orthop. 2006 Nov-Dec;26(6):785-7. doi: 10.1097/01.bpo.0000235396.57160.f1.
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Incidence and development of trigger thumb in children.儿童扳机指的发病率及发展情况。
J Hand Surg Am. 2006 Apr;31(4):541-3. doi: 10.1016/j.jhsa.2005.12.024.
10
Clinical analysis of the trigger thumb of childhood.儿童扳机指的临床分析
Turk J Pediatr. 2003 Jul-Sep;45(3):237-9.