Altahawi Faysal F, Owendoff Gregory, Lungu Eugen, Forney Michael
Department of Diagnostic Radiology, Cleveland Clinic, Cleveland, OH, USA.
Cleveland Clinic Lerner College of Medicine, Cleveland, OH, USA.
Skeletal Radiol. 2025 Sep 6. doi: 10.1007/s00256-025-05028-8.
To retrospectively evaluate outcomes of an ultrasound-guided A1 pulley fenestration release technique using small-gauge (hypodermic or spinal) needles for the treatment of trigger finger (TF).
A retrospective chart review of all TF fenestration release procedures performed by two musculoskeletal radiologists between July 2020 and August 2024 was conducted. The technique included a steroid injection after release. Preprocedural and postprocedural functional Quinnell grades and any immediate complications from the procedure report were primary outcome measures. Clinical pain score, functional outcomes, other TF interventions, and delayed complications were secondary outcome measures.
A total of 119 procedures were performed in 92 patients (61% women, mean age 63 ± 13 years), with 95 procedures (80%) following prior TF injection with refractory symptoms. Periprocedural Quinnell grades were reported in 99 procedures (83%), with immediately improved scores for all (median-preprocedural-to-postprocedural, 3-to-0; p < 0.001). Retrospective follow-up data were available for 60 procedures (50%), of which 70% experienced functional improvement. Pain scores were significantly improved at follow-up (median-preprocedural-to-follow-up, 4-to-0.5; p = 0.046). Subsequent interventions occurred following 22 cases (18%), of which 15 (13%) required additional steroid injections, 3 (3%) required repeat fenestration, and 5 (4%) required surgical release. No immediate or delayed complications were otherwise reported. Higher Quinnell grade at end of procedure predicted increased rates of follow-up (OR = 3.17, p = 0.012) and suggested worse functional status at follow-up (OR = 0.25, p = 0.054), and smaller peri-procedural improvement increased odds of additional intervention (OR = 0.48, p < 0.001).
Ultrasound-guided fenestration is an effective and safe treatment for TF in the outpatient setting.
回顾性评估使用小口径（皮下或脊椎）针头的超声引导下A1滑车开窗松解技术治疗扳机指（TF）的效果。
对2020年7月至2024年8月期间两位肌肉骨骼放射科医生进行的所有TF开窗松解手术进行回顾性病历审查。该技术包括松解后注射类固醇。术前和术后的功能Quinnell分级以及手术报告中的任何即刻并发症为主要观察指标。临床疼痛评分、功能结果、其他TF干预措施和延迟并发症为次要观察指标。
92例患者共进行了119次手术（61%为女性，平均年龄63±13岁），其中95次手术（80%）是在先前TF注射后出现难治性症状的情况下进行的。99次手术（83%）报告了围手术期Quinnell分级，所有患者的评分均立即改善（术前中位数至术后中位数，3至0；p<0.001）。60次手术（50%）有回顾性随访数据，其中70%的患者功能得到改善。随访时疼痛评分显著改善（术前中位数至随访中位数，4至0.5；p=0.046）。22例（18%）患者随后进行了干预，其中15例（13%）需要额外注射类固醇，3例（3%）需要重复开窗，5例（4%）需要手术松解。未报告其他即刻或延迟并发症。手术结束时较高的Quinnell分级预测随访率增加（OR=3.17，p=0.012），并提示随访时功能状态较差（OR=0.25，p=0.054），围手术期改善较小增加了额外干预的几率（OR=0.48，p<0.001）。
超声引导下开窗术是门诊治疗TF的一种有效且安全的方法。
