Hansen Rehne L, Søndergaard Morten, Lange Jeppe
Center for Planned Surgery, Regional Hospital Silkeborg, Silkeborg, Aarhus C, Denmark; Orthopaedic Research Unit, Department of Orthopaedic Surgery, Aarhus University Hospital, Aarhus C, Denmark.
Center for Planned Surgery, Regional Hospital Silkeborg, Silkeborg, Aarhus C, Denmark.
J Hand Surg Am. 2017 May;42(5):359-366. doi: 10.1016/j.jhsa.2017.02.011. Epub 2017 Mar 22.
Trigger finger is a common condition with a lifetime prevalence of 2%. Corticosteroid injection is a treatment often considered as a first-line intervention with reported cure rates between 60% and 90% in observational cohorts. Nevertheless, open surgery remains the most effective treatment with reported cure rates near 100%. Head-to-head trials on these treatments are limited. We investigated the efficacy of open surgery compared with ultrasound-guided corticosteroid injections.
The study was performed as a single-center, randomized, controlled trial with a 1-year follow-up. A total of 165 patients received either open surgery (n = 81) or ultrasound-guided corticosteroid injection (n = 84). Follow-up was conducted at 3 and 12 months. If the finger had normal movement or normal movement with discomfort at latest follow-up, the outcome was considered a success. Secondary outcomes were postprocedural pain and complications.
The groups were similar at baseline except for lower alcohol consumption in the open surgery group. At 3 months, 86% and 99% were successfully treated after corticosteroid injection and open surgery, respectively. At 12 months, 49% and 99% were considered successfully treated after corticosteroid injection and open surgery, respectively. The pain score at latest follow-up was significantly higher in the corticosteroid injection group. Complications after open surgery were more severe and included 3 superficial infections and 1 iatrogenic nerve lesion. After corticosteroid injection 11 patients experienced a steroid flare and 2 had fat necrosis at the site of injection.
Open surgery is superior to ultrasound-guided corticosteroid injections. Complications after open surgery are more severe; this must be taken into account when advising patients with regard to treatment.
TYPE OF STUDY/LEVEL OF EVIDENCE: Therapeutic I.
扳机指是一种常见病症，终生患病率为2%。皮质类固醇注射是一种常被视为一线干预措施的治疗方法，在观察性队列研究中报告的治愈率在60%至90%之间。然而，开放性手术仍然是最有效的治疗方法，报告的治愈率接近100%。关于这些治疗方法的直接对比试验有限。我们研究了开放性手术与超声引导下皮质类固醇注射的疗效。
该研究作为一项单中心、随机、对照试验进行，随访1年。共有165例患者接受了开放性手术（n = 81）或超声引导下皮质类固醇注射（n = 84）。在3个月和12个月时进行随访。如果手指在最近一次随访时活动正常或活动正常但有不适，则结果被视为成功。次要结果是术后疼痛和并发症。
除开放性手术组饮酒量较低外，两组在基线时相似。在3个月时，皮质类固醇注射和开放性手术后分别有86%和99%的患者得到成功治疗。在12个月时，皮质类固醇注射和开放性手术后分别有49%和99%的患者被视为成功治疗。皮质类固醇注射组在最近一次随访时的疼痛评分明显更高。开放性手术后的并发症更严重，包括3例浅表感染和1例医源性神经损伤。皮质类固醇注射后，11例患者出现类固醇性炎症反应，2例在注射部位出现脂肪坏死。
开放性手术优于超声引导下皮质类固醇注射。开放性手术后的并发症更严重；在为患者提供治疗建议时必须考虑到这一点。
研究类型/证据水平：治疗性I级。
