Farr Sebastian, Mataric Teofil, Kroyer Bettina, Barik Sitanshu
Department of Pediatric Orthopaedics and Foot and Ankle Surgery, Orthopaedic Hospital Speising, Vienna, Austria.
Department of Surgery, Krankenhaus Göttlicher Heiland, Vienna, Austria.
Bone Jt Open. 2024 Sep 4;5(9):736-741. doi: 10.1302/2633-1462.59.BJO-2024-0056.R1.
The paediatric trigger thumb is a distinct clinical entity with unique anatomical abnormalities. The aim of this study was to present the long-term outcomes of A1 pulley release in idiopathic paediatric trigger thumbs based on established patient-reported outcome measures.
This study was a cross-sectional, questionnaire-based study conducted at a tertiary care orthopaedic centre. All cases of idiopathic paediatric trigger thumbs which underwent A1 pulley release between 2004 and 2011 and had a minimum follow-up period of ten years were included in the study. The abbreviated version of the Disabilities of Arm, Shoulder and Hand questionnaire (QuickDASH) was administered as an online survey, and ipsi- and contralateral thumb motion was assessed.
A total of 67 patients completed the survey, of whom 63 (94%) had full interphalangeal joint extension or hyperextension. Severe metacarpophalangeal joint hyperextension (> 40°) was documented in 15 cases (22%). The median QuickDASH score was 0 (0 to 61), indicating excellent function at a median follow-up of 15 years (10 to 19). Overall satisfaction was high, with 56 patients (84%) reporting the maximal satisfaction score of 5. Among 37 patients who underwent surgery at age ≤ two years, 34 (92%) reported the largest satisfaction, whereas this was the case for 22 of 30 patients (73%) with surgery at aged > two years (p = 0.053). Notta's nodule resolved in 49 patients (73%) at final follow-up. No residual triggering or revision surgery was observed.
Surgical release of A1 pulley in paediatric trigger thumb is an acceptable procedure with excellent functional long-term outcomes. There was a trend towards higher satisfaction with earlier surgery among the patients.
小儿扳机指是一种具有独特解剖异常的独特临床实体。本研究的目的是基于既定的患者报告结局指标，呈现特发性小儿扳机指A1滑车松解术的长期疗效。
本研究是在一家三级护理骨科中心进行的横断面问卷调查研究。纳入2004年至2011年间接受A1滑车松解术且随访期至少为10年的所有特发性小儿扳机指病例。采用手臂、肩部和手部功能障碍问卷简版（QuickDASH）进行在线调查，并评估患侧和对侧拇指活动度。
共有67例患者完成调查，其中63例（94%）指间关节完全伸直或过伸。15例（22%）记录到掌指关节严重过伸（>40°）。QuickDASH评分中位数为0（0至61），表明在中位随访15年（10至19年）时功能极佳。总体满意度较高，56例患者（84%）报告满意度最高分为5分。在37例2岁及以下接受手术的患者中，34例（92%）报告满意度最高，而在30例2岁以上接受手术的患者中，22例（73%）报告满意度最高（p = 0.053）。在最终随访时，49例患者（73%）的诺塔结节消失。未观察到残留扳机现象或翻修手术。
小儿扳机指的A1滑车手术松解是一种可接受的手术，长期功能疗效极佳。患者中存在早期手术满意度更高的趋势。
