Thakker Arjuna, Johnson Nicholas, Dias Joseph
Academic Team of Musculoskeletal Surgery, Leicester General Hospital, Leicester, United Kingdom.
The Pulvertaft Hand Centre, Royal Derby Hospital, Derby, United Kingdom.
J Clin Orthop Trauma. 2024 Oct 29;58:102790. doi: 10.1016/j.jcot.2024.102790. eCollection 2024 Nov.
The literature surrounding how different patient, sociodemographic, and anatomical factors influence surgical treatment of De Quervain's tendinopathy (DQT) is limited.
We hypothesised that different patient, anatomical, or sociodemographic factors influence the management of DQT with regard to non-operative vs. surgical management.
This retrospective cross-sectional study reviewed 155 cases of patients with DQT seen over a 10 year period. Patient-specific factors included age, gender, hand affected, dominant hand, steroid injection given and mean number of injections. Sociodemographic factors included ethnicity, employment, and deprivation, were measured using deprivation quintiles through The Index of Multiple Deprivation. Anatomical factors included the presence of subcompartmentalization, number of APL and EPB tendon slips, tendon thickening, exudative tenosynovitis, hypervascularization, and the presence of a sheath ganglion Patients were categorized into either non-operative or surgical cohort. Bivariate analysis was used to compare factors between the cohorts, and significant factors (p < 0.05) were included in the logistic regression model, used to predict factors influencing surgical management.
Bivariate analysis detected a significant difference in the mean number of steroids given between the non-operative and surgical cohort (p = 0.001) patient factors. For sociodemographic factors, a significant difference was found between deprivation quintiles (p = 0.02). From the anatomical factors, the surgical cohort had more patients with multiple APL tendon slips (p = 0.02) and the presence of a tendon ganglion sheath ganglion (p = 0.02). For patient and sociodemographic factors, logistic regression identified that the number of steroids (per patient) and being in deprivation quintile 4 were associated with surgical treatment. For anatomical factors, multiple APL tendon slips and the presence of a tendon sheath ganglion were associated with the surgical treatment.
This study suggests that several factors are associated with the need for surgical treatment of DQT, including the number of steroid injections received, social deprivation, and anatomical factors, such as the presence of multiple tendon slips and a tendon sheath ganglion. Our findings add to the growing body of literature exploring factors that may influence treatment pathways for patients with DQT.
关于不同患者、社会人口统计学和解剖学因素如何影响桡骨茎突狭窄性腱鞘炎（DQT）手术治疗的文献有限。
我们假设不同的患者、解剖学或社会人口统计学因素会影响DQT在非手术与手术治疗方面的管理。
这项回顾性横断面研究回顾了10年间诊治的155例DQT患者。患者特异性因素包括年龄、性别、患侧手、优势手、是否接受类固醇注射及平均注射次数。社会人口统计学因素包括种族、就业情况和贫困程度，通过多重贫困指数使用贫困五分位数进行衡量。解剖学因素包括是否存在亚分区、拇长展肌（APL）和拇短伸肌（EPB）肌腱束的数量、肌腱增厚、渗出性腱鞘炎、血管增生以及腱鞘囊肿的存在。患者被分为非手术组或手术组。采用双变量分析比较两组之间的因素，将有显著差异的因素（p < 0.05）纳入逻辑回归模型，用于预测影响手术治疗的因素。
双变量分析发现，非手术组和手术组之间在患者因素方面给予类固醇的平均次数存在显著差异（p = 0.001）。对于社会人口统计学因素，贫困五分位数之间存在显著差异（p = 0.02）。在解剖学因素方面，手术组有更多患者存在多条APL肌腱束（p = 0.02）以及腱鞘囊肿（p = 0.02）。对于患者和社会人口统计学因素，逻辑回归表明（每位患者）类固醇注射次数以及处于贫困五分位数4与手术治疗相关。对于解剖学因素，多条APL肌腱束和腱鞘囊肿的存在与手术治疗相关。
本研究表明，有几个因素与DQT手术治疗的需求相关，包括接受类固醇注射的次数、社会贫困程度以及解剖学因素，如多条肌腱束的存在和腱鞘囊肿。我们的研究结果增加了探索可能影响DQT患者治疗途径因素的文献数量。
