Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA.
Cincinnati Children's Hospital, Division of Orthopaedics, Cincinnati, OH.
J Hand Surg Am. 2023 Jul;48(7):665-672. doi: 10.1016/j.jhsa.2023.03.015. Epub 2023 May 29.
Pediatric trigger finger (PTF) is an acquired condition that is uncommon and anatomically complex. Currently, the literature is characterized by a small number of retrospective case series with limited sample sizes. This investigation sought to evaluate the presentation, management, and treatment outcomes of PTF in a large, multicenter cohort.
A retrospective review of pediatric patients with a diagnosis of PTF between 2009 and 2020 was performed at three tertiary referral hospitals. Patient demographics, PTF characteristics, treatment strategies, and outcomes were abstracted from the electronic medical records. Patients and families also were contacted by telephone to assess the downstream persistence or recurrence of triggering symptoms.
In total, 321 patients with 449 PTFs were included at a mean follow-up of 3.9 ± 4.0 years. There were approximately equal numbers of boys and girls, and the mean age of symptom onset was 5.4 ± 5.1 years. The middle (34.7%) and index (11.6%) fingers were the most and least commonly affected digits, respectively. Overall, PTFs managed operatively achieved significantly higher rates of complete resolution compared with PTFs managed nonsurgically (97.1% vs 30.0%). Seventy-five percent of PTFs that achieved complete resolution with nonsurgical management did so within 6 months, and approximately 90% did so within 12 months. Patients with multidigit involvement, higher Quinnell grade at presentation, or palpable nodularity were significantly more likely to undergo surgery. There was no significant difference in the rate of complete resolution between splinted versus not splinted PTFs or across operative techniques.
Only 30% of the PTFs managed nonsurgically achieved complete resolution. Splinting did not improve resolution rates in children treated nonsurgically. In contrast, surgical intervention has a high likelihood of restoring motion and function of the affected digit.
TYPE OF STUDY/LEVEL OF EVIDENCE: Therapeutic IV.
小儿扳机指（PTF）是一种罕见且解剖结构复杂的获得性疾病。目前，文献主要为少数回顾性病例系列研究，样本量有限。本研究旨在评估在一个大型多中心队列中 PTF 的表现、治疗方法和治疗结果。
对 2009 年至 2020 年期间在三家三级转诊医院诊断为 PTF 的儿科患者进行回顾性研究。从电子病历中提取患者人口统计学、PTF 特征、治疗策略和结果数据。还通过电话联系患者和家属，以评估扳机症状的持续性或复发情况。
共纳入 321 例患者的 449 个 PTF，平均随访 3.9±4.0 年。男孩和女孩的数量大致相等，症状发作的平均年龄为 5.4±5.1 岁。中指（34.7%）和食指（11.6%）是最常和最不常受累的手指。总体而言，与非手术治疗相比，手术治疗的 PTF 完全缓解率显著更高（97.1% vs. 30.0%）。75%的非手术治疗完全缓解的 PTF 在 6 个月内缓解，约 90%在 12 个月内缓解。多手指受累、就诊时 Quinnell 分级较高或可触及结节的患者更有可能接受手术。未固定与固定的 PTF 或不同手术技术之间的完全缓解率无显著差异。
只有 30%的非手术治疗的 PTF 完全缓解。夹板固定并不能提高非手术治疗儿童的缓解率。相比之下，手术干预有很大的可能性恢复受影响手指的运动和功能。
研究类型/证据水平：治疗性 IV 级。
