Amirfeyz R, McNinch R, Watts A, Rodrigues J, Davis T R C, Glassey N, Bullock J
1 Trauma and Orthopaedics, Bristol Royal Infirmary, Bristol, UK.
2 Upper Limb Unit, Wrightington Hospital, Wigan, UK.
J Hand Surg Eur Vol. 2017 Jun;42(5):473-480. doi: 10.1177/1753193416682917. Epub 2016 Dec 21.
The aim of this systematic review was to develop an evidence-based guideline to assist clinicians in the treatment of adult trigger digits. There is moderate evidence to suggest that local corticosteroid injection is a safe and effective short-term treatment and it may, therefore, be recommended as an initial treatment for this condition. However, when compared with surgery, there is strong evidence that corticosteroid injection is associated with increased rates of ongoing or recurrent symptoms at 6 months after intervention. There is strong evidence suggesting that trigger digit can be managed safely by surgical release. There is weak evidence to support the use of splinting or other non-operative modalities. Hence a single corticosteroid injection may be offered as the first line in treatment of adult trigger digits, but percutaneous release is a safe alternative. Surgery should be the next line if the injection fails, symptoms recur or the patient chooses.
I.
本系统评价的目的是制定基于证据的指南，以协助临床医生治疗成人扳机指。有中等证据表明局部皮质类固醇注射是一种安全有效的短期治疗方法，因此可推荐作为该病的初始治疗方法。然而，与手术相比，有强有力的证据表明皮质类固醇注射与干预后6个月持续或复发症状的发生率增加有关。有强有力的证据表明，扳机指可通过手术松解安全治疗。支持使用夹板或其他非手术方式的证据不足。因此，单次皮质类固醇注射可作为成人扳机指治疗的一线方法，但经皮松解是一种安全的替代方法。如果注射失败、症状复发或患者选择，手术应作为下一步治疗。
I级。
