Department of Orthopaedics, Faculty of Medicine Ramathibodi Hospital, Mahidol University.
Department of Preventive and Social Medicine, Faculty of Medicine, Chulalongkorn University.
J Pediatr Orthop B. 2021 Jul 1;30(4):351-357. doi: 10.1097/BPB.0000000000000809.
To estimate and rank cure and recurrence rates between conservative and operative treatments for trigger thumb in children. A systematic review was conducted by searching PubMed and Scopus. Eligible criteria were comparative studies included non-syndromic trigger thumbs, aged up to 10 years, reported at least 20 thumbs and followed up at least 12 months. Two assessors independently extracted data and appraised for cure, recurrence rates among observation, stretching, splinting, open surgery, and percutaneous surgery. We assessed the risk of bias in non-randomized studies of interventions. A network meta-analysis, and probability of being the best outcomes were estimated with surface under the cumulative ranking curves (SUCRA). From 6853 searched articles, eight studies (799 children and 981 thumbs) were included. Mean age was 1.87-2.83 years and average followed up time was 1-5.7 years. Open surgery, percutaneous release, splinting, and stretching had higher cure rate than observation; pooled risk ratio (95% confidence interval) of 2.06 (1.53-2.78), 1.79 (1.26-2.53), 1.76 (1.30-2.36), and 1.37 (0.93-2.03), respectively. Percutaneous release increased risk of recurrence 3.29 times (1.42-7.60) when compared with open surgery. The best cure rates were open surgery (SUCRA = 95) followed by splint (SUCRA = 63.4), and percutaneous technique (SUCRA= 62.8). The highest recurrence rates were percutaneous (SUCRA = 97.3), and open surgery (SUCRA = 62.4). Splint is the most appropriate intervention for pediatric trigger thumb. After failed conservative methods, open surgery is considered for operative treatment. Level of evidence: Therapeutic study level II-III.
评估和比较儿童扳机指保守治疗与手术治疗的治愈率和复发率。通过检索 PubMed 和 Scopus 进行系统评价。纳入标准为：非综合征性扳机指、年龄在 10 岁以下、至少报告 20 例拇指、随访时间至少 12 个月的比较研究。两名评估员独立提取数据，并评估观察、拉伸、夹板、开放手术和经皮手术的治愈率和复发率。我们评估了非随机干预研究的偏倚风险。使用累积排序曲线下面积（SUCRA）估计网络荟萃分析和成为最佳结果的概率。从 6853 篇检索文章中，纳入了 8 项研究（799 例儿童和 981 例拇指）。平均年龄为 1.87-2.83 岁，平均随访时间为 1-5.7 年。开放手术、经皮松解、夹板和拉伸的治愈率高于观察组；汇总风险比（95%置信区间）分别为 2.06（1.53-2.78）、1.79（1.26-2.53）、1.76（1.30-2.36）和 1.37（0.93-2.03）。与开放手术相比，经皮松解增加复发风险 3.29 倍（1.42-7.60）。最佳治愈率分别为开放手术（SUCRA=95），其次是夹板（SUCRA=63.4）和经皮技术（SUCRA=62.8）。复发率最高的是经皮（SUCRA=97.3）和开放手术（SUCRA=62.4）。夹板是治疗儿童扳机指最适宜的方法。在保守治疗失败后，考虑手术治疗。证据水平：治疗研究 II-III 级。
