Silva Paulo Henrique Jeronimo da, Moraes Vinícius Ynoe de, Segre Nicolau Granado, Sato Edson Sasahara, Faloppa Flávio, Belloti João Carlos
Departamento de Ortopedia e Traumatologia, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, Brasil.
Rev Bras Ortop (Sao Paulo). 2021 Apr;56(2):181-191. doi: 10.1055/s-0040-1721363. Epub 2020 Oct 29.
The present paper aims to evaluate the therapeutic planning for trigger finger by Brazilian orthopedists. This is a cross-sectional study with a population composed of participants from the 2018 Brazilian Congress on Orthopedics and Traumatology (CBOT-2018, in the Portuguese acronym), who answered a questionnaire about the conduct adopted for trigger finger diagnosis and treatment. A total of 243 participants were analyzed, with an average age of 37.46 years old; most participants were male (88%), with at least 1 year of experience (55.6%) and from Southeast Brazil (68.3%). Questionnaire analysis revealed a consensus on the following issues: diagnosis based on physical examination alone (73.3%), use of the Quinnell classification modified by Green (58.4%), initial nonsurgical treatment (91.4%), infiltration of steroids combined with an anesthetic agent (61.7%), nonsurgical treatment time ranging from 1 to 3 months (52.3%), surgical treatment using the open approach (84.4%), mainly the transverse open approach (51%), triggering recurrence as the main nonsurgical complication (58%), and open surgery success in > 90% of the cases (63%), with healing intercurrences (54%) as the main complication. There was no consensus on the remaining variables. Orthopedists with different practicing times disagree on treatment duration ( = 0.013) and on the complication rate of open surgery ( = 0.010). Brazilian orthopedists prefer to diagnose trigger finger with physical examination alone, to classify it according to the Quinnell method modified by Green, to institute an initial nonsurgical treatment, to perform infiltrations with steroids and local anesthetic agents, to sustain the nonsurgical treatment for 1 to 3 months, and to perform the surgical treatment using a transverse open approach; in addition, they state that the main nonsurgical complication was triggering recurrence, and report open surgery success in > 90% of the cases, with healing intercurrences as the main complication.
本文旨在评估巴西骨科医生针对扳机指的治疗方案。 这是一项横断面研究，研究对象为参加2018年巴西骨科与创伤学大会（葡萄牙语简称为CBOT - 2018）的人员，他们回答了一份关于扳机指诊断和治疗所采用方法的问卷。 总共分析了243名参与者，平均年龄为37.46岁；大多数参与者为男性（88%），至少有1年工作经验（55.6%），来自巴西东南部（68.3%）。问卷分析显示在以下问题上存在共识：仅基于体格检查进行诊断（73.3%）、采用格林修改后的奎内尔分类法（58.4%）、初始非手术治疗（91.4%）、类固醇与麻醉剂联合注射（61.7%）、非手术治疗时间为1至3个月（52.3%）、采用开放手术方式进行手术治疗（84.4%），主要是横向开放手术（51%）、扳机复发作为主要的非手术并发症（58%）以及开放手术成功率>90%的病例占63%，愈合并发症状况（54%）为主要并发症。在其余变量上未达成共识。不同执业年限的骨科医生在治疗持续时间（P = 0.013）和开放手术并发症发生率（P = 0.010）上存在分歧。 巴西骨科医生更倾向于仅通过体格检查诊断扳机指，根据格林修改后的奎内尔方法进行分类，进行初始非手术治疗，使用类固醇和局部麻醉剂进行注射，将非手术治疗维持1至3个月，并采用横向开放手术方式进行手术治疗；此外，他们指出主要的非手术并发症是扳机复发，并报告开放手术成功率>90%的病例，愈合并发症状况为主要并发症。
