Department of Orthopaedics, Faculty of Medicine Vajira Hospital, Navamindradhiraj University, 681 Samsen Road, Dusit, Bangkok, 10300, Thailand.
Department of Orthopedics, Faculty of Medicine, Prince of Songkla University, 15 Karnjanavanich Road, Hat Yai, Songkhla, 90110, Thailand.
BMC Musculoskelet Disord. 2024 Nov 28;25(1):969. doi: 10.1186/s12891-024-08037-1.
De Quervain's tenosynovitis, characterized by the entrapment of the extensor pollicis brevis and abductor pollicis longus tendons in the first extensor compartment, leads to pain and swelling near the radial styloid. When conservative treatments including rest and antiinflammatory medications fail, surgery is often recommended. This study aimed to compare transverse and longitudinal skin incisions with respect to surgical scars, postoperative pain, and functional outcomes in the open release of the first extensor compartment in radial styloid tenosynovitis.
Seventy patients were randomly assigned to either the transverse or longitudinal skin incision group using a computer-generated random number table. Postoperative scarring was assessed using the Patient and Observer Scar Assessment Scale (POSAS), pain intensity using a verbal numerical rating scale, and functional outcomes using the Thai version of the Patient-Rated Wrist Evaluation (PRWE) questionnaire at 2, 6, and 12 weeks post-surgery. Continuous data were presented as mean ± standard deviation for normally distributed data or as median (interquartile range) for skewed distributions.
Following surgery, both groups showed marked improvements in Thai PRWE and POSAS scores, with no differences in functional outcomes. The longitudinal incision group had significant pain reduction at 2 and 6 weeks post-surgery. By 12 weeks, pain alleviation was similar in both groups. Wound infection was not observed in any case, and three patients reported temporary paresthesia, which was not statistically significant between the groups.
Both techniques demonstrate similar improvements in functional scores and reductions in pain scores, with no significant differences in complication rates, particularly concerning hypertrophic scars. The decision between transverse and longitudinal skin incisions should consider the surgeon's expertise, the patient's anatomical characteristics, and the complexity of the surgical procedure. Each approach presents distinct trade-offs, highlighting the necessity of a personalized, patient-centered strategy to optimize surgical outcomes.
The study was registered on 27/06/2023, at clinicaltrials.in.th (TCTR20230627001). This study was retrospectively registered.
De Quervain 腱鞘炎是由于伸拇指短肌和外展拇指长肌的肌腱在第一伸肌间隔内被卡压而引起的，表现为桡骨茎突附近疼痛和肿胀。当包括休息和抗炎药物在内的保守治疗失败时，通常推荐手术。本研究旨在比较横向和纵向皮肤切口在桡骨茎突 De Quervain 腱鞘炎的第一伸肌间隔开放松解术中的手术疤痕、术后疼痛和功能结果。
70 名患者使用计算机生成的随机数表被随机分配到横向或纵向皮肤切口组。术后采用患者和观察者瘢痕评估量表（POSAS）评估瘢痕，采用数字评分法评估疼痛强度，采用泰国版患者腕部评价问卷（PRWE）评估功能结果，分别在术后 2、6 和 12 周进行评估。连续数据用正态分布数据的均数±标准差表示，偏态分布数据用中位数（四分位数间距）表示。
手术后，两组泰国 PRWE 和 POSAS 评分均显著改善，功能结果无差异。纵向切口组术后 2 周和 6 周疼痛明显减轻。到 12 周时，两组疼痛缓解情况相似。所有病例均未发生伤口感染，3 例患者报告短暂性感觉异常，但组间无统计学差异。
两种技术在功能评分的改善和疼痛评分的降低方面均表现出相似的效果，且并发症发生率无显著差异，尤其是在肥厚性瘢痕方面。横向和纵向皮肤切口的选择应考虑到外科医生的专业知识、患者的解剖学特征和手术的复杂性。每种方法都有不同的权衡，突出了制定个性化、以患者为中心的策略以优化手术结果的必要性。
该研究于 2023 年 6 月 27 日在 clinicaltrials.in.th（TCTR20230627001）上注册。该研究为回顾性注册。
