Department of Rehabilitation, Physical Therapy Sciences & Sports, Rudolf Magnus Institute of Neuroscience - University Medical Center Utrecht, Utrecht, The Netherlands.
Department of Rehabilitation, Physical Therapy Sciences & Sports, Rudolf Magnus Institute of Neuroscience - University Medical Center Utrecht, Utrecht, The Netherlands.
Arch Phys Med Rehabil. 2018 Aug;99(8):1635-1649.e21. doi: 10.1016/j.apmr.2017.07.014. Epub 2017 Aug 30.
To provide an evidence-based overview of the effectiveness of conservative and (post)surgical interventions for trigger finger, Dupuytren disease, and De Quervain disease.
Cochrane Library, Physiotherapy Evidence Database, PubMed, Embase, and CINAHL were searched to identify relevant systematic reviews and randomized controlled trials (RCTs).
Two reviewers independently applied the inclusion criteria to select potential studies.
Two reviewers independently extracted the data and assessed the methodologic quality.
A best-evidence synthesis was performed to summarize the results. Two reviews (trigger finger and De Quervain disease) and 37 randomized controlled trials (RCTs) (trigger finger: n=8; Dupuytren disease: n=14, and De Quervain disease: n=15) were included. The trials reported on oral medication (Dupuytren disease), physiotherapy (De Quervain disease), injections and surgical treatment (trigger finger, Dupuytren disease, and De Quervain disease), and other conservative (De Qervain disease) and postsurgical treatment (Dupuytren disease). Moderate evidence was found for the effect of corticosteroid injection on the very short term for trigger finger, De Quervain disease, and for injections with collagenase (30d) when looking at all joints, and no evidence was found when looking at the PIP joint for Dupuytren disease. A thumb splint as additive to a corticosteroid injection seems to be effective (moderate evidence) for De Quervain disease (short term and midterm). For Dupuytren disease, use of a corticosteroid injection within a percutaneous needle aponeurotomy in the midterm and tamoxifen versus a placebo before or after a fasciectomy seems to promising (moderate evidence). We also found moderate evidence for splinting after Dupuytren surgery in the short term.
In recent years, more and more RCTs have been conducted to study treatment of the aforementioned hand disorders. However, more high-quality RCTs are still needed to further stimulate evidence-based practice for patients with trigger finger, Dupuytren disease, and De Quervain disease.
提供关于扳机指、掌腱膜挛缩症和桡骨茎突狭窄性腱鞘炎保守和（术后）干预措施有效性的循证综述。
Cochrane 图书馆、物理治疗证据数据库、PubMed、Embase 和 CINAHL 被检索以确定相关的系统评价和随机对照试验（RCT）。
两名审查员独立应用纳入标准选择潜在的研究。
两名审查员独立提取数据并评估方法学质量。
进行最佳证据综合以总结结果。纳入了 2 项综述（扳机指和桡骨茎突狭窄性腱鞘炎）和 37 项随机对照试验（RCT）（扳机指：n=8；掌腱膜挛缩症：n=14，桡骨茎突狭窄性腱鞘炎：n=15）。这些试验报告了口服药物（掌腱膜挛缩症）、物理治疗（桡骨茎突狭窄性腱鞘炎）、注射和手术治疗（扳机指、掌腱膜挛缩症和桡骨茎突狭窄性腱鞘炎）以及其他保守治疗（桡骨茎突狭窄性腱鞘炎）和术后治疗（掌腱膜挛缩症）。在非常短期、所有关节注射皮质类固醇和注射胶原酶（30d）时，发现皮质类固醇注射对扳机指、桡骨茎突狭窄性腱鞘炎有中等证据，而在掌腱膜挛缩症的 PIP 关节则没有发现证据。在桡骨茎突狭窄性腱鞘炎中，将皮质类固醇注射与拇指夹板联合使用似乎在短期和中期有效（中等证据）。对于掌腱膜挛缩症，在中期使用经皮针刀松解术时注射皮质类固醇以及在筋膜切开术前或术后使用他莫昔芬与安慰剂相比似乎有前景（中等证据）。我们还发现掌腱膜挛缩术后短期夹板固定有中等证据。
近年来，越来越多的 RCT 被用于研究上述手部疾病的治疗方法。然而，仍然需要更多高质量的 RCT 来进一步促进扳机指、掌腱膜挛缩症和桡骨茎突狭窄性腱鞘炎患者的循证实践。
