影响复发性扳机指经重复皮质类固醇注射治疗成功的因素：一项前瞻性队列研究。
Factors Influencing the Successful Treatment of Recurrent Trigger Finger With Repeated Corticosteroid Injections: A Prospective Cohort Study.
机构信息
Faculty of Medicine, Department of Orthopaedics, Chulalongkorn University, King Chulalongkorn Memorial Hospital, Bangkok, Thailand.
Faculty of Medicine, Department of Orthopaedics, Chulalongkorn University, King Chulalongkorn Memorial Hospital, Bangkok, Thailand.
出版信息
J Hand Surg Am. 2024 Mar;49(3):253-259. doi: 10.1016/j.jhsa.2023.12.002. Epub 2024 Jan 5.
PURPOSE
The aim of this study was to determine the success rate, duration of disease control, and predictive factors of success of repeated corticosteroid injections for recurrent trigger finger.
METHODS
This prospective cohort study involved patients who had recurrent trigger finger and a history of corticosteroid injections. A total 114 patients were treated with repeated corticosteroid injections and followed for 12 months. Data on demographic characteristics, comorbid conditions, and possible predictive factors for successful treatment from medical chart reviews and direct patient interviews were compared. Patients were classified into success or failure groups at one, three, six, and 12 months after the initial injection. The relationship between hypothesized predictors and success or failure after repeated corticosteroid injection was analyzed with multivariable logistic regression.
RESULTS
The overall success rates from repeated cortisone injections after one, three, six, and 12 months were 97.4%, 84.2%, 68.4%, and 49.1%, respectively. Multivariable logistic regression modeling revealed that a high grade of disease (grade III or IV based on the Quinnell system), a body mass index (BMI) ≥ 25 kg/m, and a short symptom-free period (< six months) after a previous injection were strong predictors of symptom recurrence (odds ratio = 3.6 [95% CI 1.5-8.4], odds ratio = 2.5 [95% CI 1.1-5.9], and odds ratio = 1.8 [95% CI 1.1-3.0], respectively). The average success rates for patients at 1-year according to the number of risk factors were as follows: none of the three risk factors, 73.3%; one risk factor, 54.2% to 63.6% (54.2% for grade III-IV triggering, 63.6% for BMI ≥ 25 kg/m and 63.6% for < 6-month symptom-free period); two risk factors, 30% to 75% (30% for a combination of grade III-IV and BMI ≥ 25 kg/m, 45.5% with grade II-IV and < 6-month period, and 75% with a combination of < 6-month period and BMI ≥ 25 kg/m); and all three risk factors, 11.8%.
CONCLUSIONS
Repeated corticosteroid injections for recurrent trigger finger should be considered in patients who prefer nonsurgical treatment, especially in those without factors predictive of failure.
TYPE OF STUDY/LEVEL OF EVIDENCE: Prognostic II.
目的
本研究旨在确定复发性扳机指患者接受重复皮质类固醇注射治疗的成功率、疾病控制持续时间和成功的预测因素。
方法
这项前瞻性队列研究纳入了患有复发性扳机指和皮质类固醇注射史的患者。114 例患者接受重复皮质类固醇注射治疗，并随访 12 个月。通过病历回顾和直接患者访谈收集人口统计学特征、合并症和可能的治疗成功预测因素的数据。在初始注射后 1、3、6 和 12 个月，将患者分为成功组和失败组。采用多变量逻辑回归分析假设预测因素与重复皮质类固醇注射后的成功或失败之间的关系。
结果
重复皮质类固醇注射后 1、3、6 和 12 个月的总体成功率分别为 97.4%、84.2%、68.4%和 49.1%。多变量逻辑回归模型显示，疾病严重程度（根据 Quinnell 系统分为 III 级或 IV 级）、体质指数（BMI）≥25kg/m²和前一次注射后无症状期较短（<6 个月）是症状复发的强预测因素（比值比分别为 3.6[95%CI 1.5-8.4]、2.5[95%CI 1.1-5.9]和 1.8[95%CI 1.1-3.0]）。根据危险因素数量，1 年内患者的平均成功率如下：无三个危险因素，73.3%；一个危险因素，54.2%至 63.6%（III-IV 级扳机，54.2%；BMI≥25kg/m²，63.6%；无症状期<6 个月，63.6%）；两个危险因素，30%至 75%（III-IV 级和 BMI≥25kg/m²的组合，30%；II-IV 级和无症状期<6 个月的组合，45.5%；无症状期<6 个月和 BMI≥25kg/m²的组合，75%）；三个危险因素全部，11.8%。
结论
对于喜欢非手术治疗的患者，尤其是无失败预测因素的患者，应考虑对复发性扳机指进行重复皮质类固醇注射治疗。
研究类型/证据水平：预后 II 级。
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