The CORE Institute, Phoenix, AZ, USA.
The University of Arizona, Phoenix, USA.
Hand (N Y). 2020 May;15(3):399-406. doi: 10.1177/1558944718796559. Epub 2018 Sep 21.
Open surgical release of the A1 pulley is the definitive treatment for the common hand condition of trigger finger, or inflammatory stenosing tenosynovitis. Anecdotal evidence among hand surgeons has questioned whether or not recent steroid injection may be related to complications following open trigger finger release, particularly wound infection, but no studies have primarily studied this connection to date. We aimed to determine whether recent steroid injection was associated with postoperative surgical infections. We performed a retrospective chart review of 780 adult patients who had undergone open trigger finger release of 999 digits by 6 fellowship-trained hand surgeons at three affiliated hospital settings from January 1, 2014, to January 1, 2016. Data on timing of steroid injections relative to surgery, number of steroid injections, concomitant conditions, use of antibiotics, and postoperative complications including infections were gathered. Steroid injection timing relative to subsequent operative intervention correlated with postoperative surgical site infection in trigger finger release. Older age and decreasing days between steroid injection and surgery correlated with infection rates. Other factors found to be associated with infection rates included smoking, use of preoperative antibiotics, and use of lidocaine with epinephrine. The other factors examined did not correlate with infection rates. Steroid injection, smoking, increasing age, lesser number of days between steroid injection and surgery, and use of lidocaine with epinephrine are risk factors for postoperative trigger surgical infections. We recommend careful preoperative counseling regarding higher wound healing risks for smokers, avoidance of steroid injections immediately prior to an operative date, and scheduling operative dates that tend to be greater than 80 days from the date of last steroid injection. We also recommend avoidance of epinephrine in the local anesthetic solution, as this may minimize surgical site infection risks.
手术松解 A1 滑车是治疗常见手部扳机指（弹响指）或炎症性狭窄性腱鞘炎的明确方法。手部外科医生的一些传闻证据质疑近期皮质类固醇注射是否与开放扳机指松解后的并发症有关，特别是伤口感染，但迄今为止尚无研究主要研究这种联系。我们旨在确定近期皮质类固醇注射是否与术后手术感染有关。我们对 2014 年 1 月 1 日至 2016 年 1 月 1 日期间由 6 名 fellowship培训的手部外科医生在三个附属医院环境中对 780 例成年患者的 999 个手指进行的开放性扳机指松解进行了回顾性图表审查。收集了有关皮质类固醇注射相对于手术的时间、皮质类固醇注射次数、伴随疾病、抗生素使用以及包括感染在内的术后并发症的数据。皮质类固醇注射与随后手术干预的时间与扳机指松解后的手术部位感染相关。年龄较大和皮质类固醇注射与手术之间的天数减少与感染率相关。其他与感染率相关的因素包括吸烟、术前使用抗生素以及使用含肾上腺素的利多卡因。检查的其他因素与感染率无关。皮质类固醇注射、吸烟、年龄增加、皮质类固醇注射与手术之间的天数减少以及使用含肾上腺素的利多卡因是术后扳机指手术感染的危险因素。我们建议仔细进行术前咨询，告知吸烟者伤口愈合风险较高，避免在手术日期前立即进行皮质类固醇注射，并安排手术日期，使其与最后一次皮质类固醇注射的日期相差大于 80 天。我们还建议避免在局部麻醉溶液中使用肾上腺素，因为这可能最大限度地降低手术部位感染的风险。
