Shultz Kevin J, Kittinger Janae L, Czerwinski Wendy L, Weber Robert A
From Scott & White Medical Center.
Plast Reconstr Surg. 2018 Oct;142(4):983-990. doi: 10.1097/PRS.0000000000004761.
Although steroid injection remains a common first-line treatment of trigger finger, clinical experience suggests that not all cases of trigger finger respond the same. The purpose of this study was to use a classification system for trigger finger that is simple and reproducible, and produces clearly definable, clinically relevant cutoff points to determine whether responsiveness to steroid injection correlates to clinical staging.
The authors conducted a prospectively collected longitudinal study of trigger finger patients separated into four stages of severity. Each subject received a single injection of 6 mg of dexamethasone acetate. One-month outcomes were analyzed to evaluate the efficacy of steroid injection. These outcomes were further stratified based on baseline characteristics and stage of triggering.
A total of 99 digits and 69 subjects were included. Two variables were found to be significant in predicting response to initial injection: (1) multiple affected digits and (2) stage severity. Patients with multiple involved fingers were 5.8 times more likely to have no resolution of symptoms compared with those with a single affected finger. For every level of stage increase, the odds doubled for having no resolution of symptoms.
Steroid injection remains a viable first-line option for patients presenting with mild triggering (stage 1 and 2). For more severe triggering (stage 3 and 4) or multiple affected digits, the success of steroid injection is significantly lower at 1 month. For the latter patients, surgery may be a more reasonable initial treatment.
CLINICAL QUESTION/LEVEL OF EVIDENCE: Risk, II.
尽管类固醇注射仍是扳机指常见的一线治疗方法，但临床经验表明并非所有扳机指病例的反应都相同。本研究的目的是使用一种简单且可重复的扳机指分类系统，该系统能产生明确可定义的、与临床相关的临界点，以确定对类固醇注射的反应是否与临床分期相关。
作者对扳机指患者进行了一项前瞻性收集的纵向研究，将患者分为四个严重程度阶段。每位受试者接受一次6毫克醋酸地塞米松的注射。分析1个月的结果以评估类固醇注射的疗效。这些结果根据基线特征和扳机阶段进一步分层。
共纳入99个手指和69名受试者。发现两个变量在预测对初次注射的反应方面具有显著性：（1）多个受累手指和（2）阶段严重程度。与单个受累手指的患者相比，多个受累手指的患者症状无缓解的可能性高5.8倍。每增加一个阶段水平，症状无缓解的几率就会翻倍。
对于轻度扳机（1期和2期）患者，类固醇注射仍是可行的一线选择。对于更严重的扳机（3期和4期）或多个受累手指，类固醇注射在1个月时的成功率显著降低。对于后一类患者，手术可能是更合理的初始治疗方法。
临床问题/证据水平：风险，II级。
