改良月牙刀经皮挑切腱鞘治疗“扳机指”

屈指肌腱狭窄性腱鞘炎又称“扳机指”,在手外科门诊中经常遇见。作者对46例59指采用改良月牙刀经皮挑切腱鞘治疗“扳机指”取得满意效果,现报告如下。1 临床资料 46例59指,男15例,女31例;年龄最大56岁,最小21岁。发生在拇指9例,其中双拇指3例;中指27例,其中双中指6例;食指6例,无名指3例,5指同时发生1例。病程最长5年,最短2个月,平均2年零3个月。封闭在3次以上者占76％。2 刀县改良与操作 将普通月牙刀经砂轮磨制成为双刃、头尖体细长可双向运动的刀具。操作时在手指弹响最明显处消毒,用2％利多卡因2～4ml作皮下局部浸润麻醉,将刀垂直插入腱鞘部位     

儿童先天性拇指扳机指治疗结果的分析

198 9年 5月～ 2 0 0 0年 10月 ,我院共诊治儿童先天性拇指扳机指 36例 5 8指 ,按患者确诊时的年龄分为 2组。Ａ组 :6～30个月 ,均行保守疗法。Ｂ组 :3～ 12岁 ,均作手术治疗。一、资料与方法1.一般资料 :Ａ组 :共 12例 19指 ,男 2例 3指 ,女 10例 16指。Ｂ组 :共 2 4例 2 9指 ,男 6例 8指 ,女 18例 2 1指。其中 5例9指 (7～ 12岁 )已呈铰锁畸形 ,拇指发育细小。另 9例曾接受过保守治疗及鞘内注射激素治疗 ,均未奏效。2 .治疗方法 :Ａ组 :由患者家属 (事先由医生教会其操作 )每日早、中、晚 3次给患者局部应用按摩、热疗后 ,被动伸、屈拇指…     

负压封闭引流联合筋膜皮瓣转移分期手术治疗创伤后骨髓炎

目的:探讨应用负压封闭引流技术(VSD)及筋膜皮瓣转移分期手术治疗伴有皮肤缺损创伤后骨髓炎的疗效。方法:自2007年12月至2009年12月,应用负压VSD及筋膜皮瓣转移分期手术治疗创伤后骨髓炎14例,男9例,女5例;年龄20～63岁,平均36岁;所有患者均为创伤术后感染。受伤部位:胫骨9例,跟骨3例,股骨1例,尺桡骨1例。感染时间2～96周,平均32周。结果:所有患者获得随访,时间12～36个月,平均19.2个月。使用VSD清创1～3次,平均1.57次。13例患者创面伤口Ⅰ期愈合,1例有渗出,经引流换药,术后3周愈合。8例患者因骨缺损及骨折延迟愈合,Ⅱ期行自体植骨术,术后1年随访骨折均愈合,术后感染未复发。结论:负压封闭引流技术联合筋膜皮瓣转移治疗创伤术后骨髓炎能够发挥负压封闭引流技术和皮瓣转移技术的优点,缩短治疗时间,安全性及可靠性较好,是一种有效的治疗方法。     

经皮微创空心L形针刀治疗弹响指

目的探讨经皮微创空心L形针刀治疗弹响指的疗效。方法 2007年9月-2009年9月,采用自行设计的空心L形针刀微创治疗160例(202指)弹响指。男47例,女113例;年龄12～68岁,平均55岁。病程2周～1年。拇指58指,示指20指,中指46指,环指60指,小指18指。根据Quinnell分级标准:Ⅲ级63指,Ⅳ级126指,Ⅴ级13指。术中首先用空心L形针刀自皮下潜行至A1滑车部远端,向远端平行纵向切割后,自针刀空心向腱鞘部注入倍他米松。结果患者手术时间5～19 min,平均8.2 min;无手术相关并发症发生。160例均获随访,随访时间1年～3年6个月,平均1.6年。术后1周36指手术松解处疼痛,口服非甾体类消炎药后缓解。术后1周25指屈伸活动时仍存在扳机样感及顿挫感,1个月后5指恢复正常,20指症状无明显改善;其中10指再次行针刀治疗后症状缓解,余10指经1～3次针刀治疗后无缓解。术后6个月参照Quinnell分级标准评定疗效:获优165指,良27指,差10指,优良率为95.0%。结论经皮微创空心L形针刀治疗弹响指安全有效、易于操作。     

拇指掌侧推进皮瓣急诊修复拇指末端缺损

拇指末节损伤在基层医院比较常见,处理治疗方法有多种.我们应用拇指掌侧推进皮瓣急诊修复拇指末端缺损9例10指,男7例,女2例.年龄19～46岁.电锯伤5例,刀伤2例,挤压伤2例.拇指末节指腹缺损1指,部分截指9指.合并其他手指损伤8例.受伤至手术时间为30分钟～4小时.手术彻底清创.清创时末节指骨应咬除其锐角,尽量保留拇指长度及屈、伸肌腱止点.本组患者均行拇指掌侧推进皮瓣修复.自拇指两侧做纵形切口,至掌指关节处,紧贴屈指腱鞘表面分离,使皮瓣内保留双侧神经血管束不致损伤.屈曲指间关节及掌指关节,使皮瓣远端能与指甲或指背侧皮肤缝合.如皮瓣张力较大可用细钢针固定拇指关节屈曲位3周,避免皮瓣远端坏死或延迟愈合.缝合两侧皮肤切口.术后创面Ⅰ期愈合8例,Ⅱ期愈合1例.全部病例获得随访,时间为4个月～2年.活动、感觉及持物功能满意,指端皮肤两点辨别觉3～6 mm.     

第一掌骨一期延长联合虎口加深成形术治疗拇指缺损远期疗效

目的总结第1掌骨一期延长联合虎口加深成形术治疗拇指Ⅱ～Ⅲ度缺损的远期疗效。方法回顾分析1985年8月-1988年8月收治并获24年以上随访的8例拇指Ⅱ～Ⅲ度缺损患者临床资料。男5例,女3例;年龄20～53岁,平均38岁。拇指残端创面愈合至拇指再造时间为4个月～2年,平均9个月。采用第1掌骨截骨后一期延长1.8～2.0 cm再造拇指,同时作虎口"Z"字成形加深术。结果术后切口均Ⅰ期愈合。随访时间24～26年。再造拇指感觉无异常改变,均能完成对指和握持,不能完成对掌。虎口无继发挛缩,拇指内收、外展活动度30～90°,肌力5～6级。根据中华医学会手外科学会上肢部分功能评定试用标准评定,均获优良。结论第1掌骨一期延长联合虎口加深成形术治疗拇指Ⅱ～Ⅲ度缺损,具有手术操作简便、成功率高、远期疗效好等优点。     

腱鞘松解治疗6岁以上儿童拇长屈肌腱狭窄性腱鞘炎

目的探讨腱鞘松解术治疗6岁以上儿童拇长屈肌腱狭窄性腱鞘炎的疗效。方法回顾性分析2014年6月至2019年6月,我院骨科采用手术松解腱鞘治疗22例儿童拇长屈肌腱狭窄性腱鞘炎患儿资料,男7例,女15例;手术时年龄6岁1个月～9岁3个月,平均7岁4个月;单指13例(右手指6例,左手指7例),双指9例,一共31拇,其中SugimotoⅡ期2例、SugimotoⅢ期3例、SugimotoⅣ期26例,均采用手术松解腱鞘。治愈标准为拇指活动无受限,指间关节伸直达0°。结果 31拇术后获得13～73个月随访,平均(29.4±16.0)个月。末次随访时,1例术后嵌顿复发;2例与正常拇指相比,伸直轻度受限(-20°),其中有1例合并残留弹响;剩余28拇屈伸自如同正常拇指,无屈曲畸形残留及复发,治愈率达90.3%。术后拇指感觉、肌力均正常,无一例出现神经血管损伤的并发症。结论对于年龄6岁以上拇长屈肌腱狭窄性腱鞘炎患儿手术治疗治愈率高,术后并发症少。     

儿童先天性拇指多指畸形的手术时机及方法

目的 探讨儿童先天性拇指多指畸形的手术时机及方法.方法 对2007年12月至2012年2月进行手术治疗的132例154指先天性拇指多指畸形的临床资料进行回顾性分析.男性85例,女性47例;年龄2个月至13岁,平均(1.53±2.47)岁.所有患者术前均进行详细专科检查和影像学评估,根据患儿年龄、Wassel分型及畸形程度制订个体化的手术方案,包括单纯多指切除术,合并各种皮瓣成形、肌腱移位(移植)、韧带重建、关节囊修复等矫形手术,11例6岁以上的患儿酌情行截骨矫形术.结果 132倒154指中104例117指获得随访,时间为6～55个月,平均36.7个月,根据改良Tada评分进行评估,优77指,良21指,中15指,差4指;3指术后2年出现继发性成角畸形,1指术后3年掌指关节桡侧残留骨骺,再次手术后外形及功能基本恢复正常.结论 先天性拇指多指畸形的手术时机应根据拇指骨化中心出现时间而定,Wassel Ⅰ、Ⅱ型手术选择在1岁6个月远节指骨骨化中心出现后,Ⅲ、Ⅳ型则选择在1岁近节指骨骨化中心出现后,而Ⅴ、Ⅵ型选择在2岁6个月掌骨骨化中心出现后,Ⅶ型可选择在2岁6个月后进行;手术方法应遵循个体化治疗原则,侧副韧带、肌腱及关节囊重建、矫正尺偏(或桡偏)畸形是手术重点.     

自发性指伸肌腱断裂8例报告

自发性指伸肌腱断裂临床并不多见，早期常被误诊为软组织炎症、腱鞘炎等而延误治疗，笔者近5年治疗8例，报道如下。１一般资料本组8例，男7例，女1例，7例农民，1例学生。其中示指Ⅵ区1例，中指Ⅵ2例，拇指Ⅳ5例。局部肿痛病史2～4月，指不能伸直至就诊时间5～14天。拇长伸肌腱断裂均采用示指固有伸肌腱移位术修复，中、示指行同侧掌长肌腱移位。２典型病例例1：女，45岁，近3个月右腕桡侧疼痛，曾诊断为腱鞘炎，做过二次封闭治疗，无明显好转，局部仍肿痛。近5天插秧、拔秧，每天连续工作10h，疼痛明显加重，拇指伸直受限，直至不能伸展。…     

Arthrex纤维缝线固定治疗NeerⅡ型锁骨远端骨折

目的总结Arthrex纤维缝线固定治疗NeerⅡ型锁骨远端骨折的疗效。方法2004年1月-2007年12月,采用单纯Arthrex纤维缝线治疗31例NeerⅡ型锁骨远端骨折患者。其中男21例,女10例;年龄15～64岁,平均34.6岁。车祸伤17例,跌伤11例,坠落伤3例。均为急性闭合性损伤。均有肩部皮肤挫伤,局部肿胀、疼痛,患侧上臂外展及上举功能受限。其中1例合并同侧肋骨骨折。伤后至手术时间2～72h,平均12h。结果术后患者切口均Ⅰ期愈合。31例均获随访,随访时间8～26个月,平均13.7个月。X线片示所有患者骨折愈合良好,愈合时间为术后5～12周,平均7周。术后6个月基本恢复至伤前活动能力。术后1个月1例局部残留疼痛,2例肩关节功能部分受限,经对症治疗症状消失,功能恢复或基本恢复至伤前。采用美国肩关节功能评分表(ASES)评分为86～100分,平均92.7分。结论应用Arthrex纤维缝线固定治疗NeerⅡ型锁骨远端骨折,手术方法简便实用、安全可靠。     

Conservative treatment for trigger thumb in children

Conservative treatment was performed for 60 trigger thumbs (19 right, 17 left, 12 bilateral) in 48 children (19 boys, 29 girls); the age at initial diagnosis ranged from 0 to 48 months old (mean 26 months). In this approach, only passive exercise of the affected thumb was performed by the mother. As a result, two patients (two thumbs) dropped out of treatment. Fifty-six thumbs out of 58 showed a satisfactory result (96%). Sixteen thumbs (in stage 2) and eight thumbs (in stage 3) showed completely recovery. Four thumbs (in stage 3) have not yet improved. In conclusion, we suggest that conservative treatment is effective for trigger thumbs in stage 2, while surgical therapy was thought to be indicated for stage 3 before the age of 3 years to avoid flexion deformity.     

The Development of Trigger Thumb in the Contralateral Thumb in Pediatric Patients Presenting Initially With Unilateral Involvement

Background: Pediatric trigger thumb is a common condition that can occur bilaterally. There have been reports of a metachronous relationship between trigger thumbs developing in both extremities. Surgeons might consider delaying operative treatment of unilateral trigger thumb due to the concern that contralateral symptoms may develop later in childhood, requiring a second procedure and anesthetic event. Methods: We retrospectively reviewed patients diagnosed with pediatric trigger thumb from 2008 to 2016 at a large pediatric hospital. Data collected included age at presentation and onset, laterality, age and timing of onset of contralateral symptoms, time of index procedure and subsequent procedure (if any), severity of symptoms, previous treatments, range of motion, and birth history. Results: There were 198 patients with pediatric trigger thumb, with 55 patients (28%) presenting with or developing bilateral involvement. Fifty patients (25%) had bilateral involvement upon initial presentation. Five patients (3%) were subsequently diagnosed with contralateral trigger thumb after initial presentation of unilateral trigger thumb. Average time to contralateral trigger thumb development was 12 months after presentation in unilateral patients. Most patients presented with locked flexion contracture with palpable Notta’s nodule. Of the 5 patients who developed contralateral trigger thumbs, three required a second surgery after the index procedure. Conclusions: The vast majority of patients with bilateral trigger thumbs had bilateral involvement upon initial presentation to the pediatric hand clinic. Given the rarity of bilateral symptoms after initial unilateral presentation, we do not recommend delayed surgical intervention for patients with unilateral disease in children over 3 years of age.     

Efficacy of cortisone injection in treatment of trigger fingers and thumbs

One hundred eight trigger fingers and thumbs in 74 consecutive patients were treated by injections of triamcinalone and followed for an average of 3 1/2 years. Minimum follow-up was 1 year. Eighty four percent of trigger fingers and 92% of trigger thumbs were cured with a single injection, and a repeat injection for treatment of recurrent symptoms raised these figures to 91% and 97%, respectively. All injections were done by one physician. There were no complications. We conclude that intrasynovial injection of a steroid compound is the appropriate initial treatment for trigger fingers and thumbs.     

Extension splint for trigger thumb in children

Sixty-two reducible trigger thumbs in 50 children with age from 0 to 4 years (mean, 1 year 11 months) were reviewed to study the effect of splinting. Thirty-one thumbs in 24 children received splinting for a mean of 11.7 weeks. The other 31 thumbs in 26 children were only observed. The results were categorized as cured, improved, or nonimproved. Follow-up was conducted after a mean of 20 months (age, 43 months). Result in the splinted group showed cured in 12 thumbs, improved in 10 thumbs, and nonimproved in 9 thumbs, whereas in the observed group, result showed 4, 3, and 24, respectively. Splinting results in 71% trigger thumbs cured or improved that is better than observation alone. The subsequent surgical release for the nonimproved trigger thumbs after splinting still had excellent results. Because surgical release for trigger thumb is not urgent, we suggest extension splinting to be a treatment option before the elective surgery.     

小儿手部屈肌腱鞘炎的保守治疗

【摘要】 目的 研究小儿手部屈肌腱鞘炎保守治疗的可行性。方法〓本文收集了25例29指的小儿手部屈肌腱鞘炎。所有病例采用局部激素注射,密切临床观察。结果〓全部25例应用局部激素注射的小儿获得6个月到8年的随访(平均18月)。80%治愈;20%症状消失,尚可以摸到小硬块。没有1例需要手术治疗。讨论〓应用激素局部注射的保守疗法是小儿手部屈肌腱鞘炎是一种有效的治疗方法。     

Conservative treatment of pediatric trigger thumb: follow-up for over 4 years

We analyzed the outcomes of our conservative treatment for pediatric trigger thumb. Since March 2004, we have used conservative treatment for all patients with pediatric trigger thumb. We prospectively analyzed 30 patients in whom 35 thumbs were affected (10 right, 15 left, 5 bilateral). The mean age at diagnosis was 28 (11-50) months. The treatment consisted of passive exercises performed by the children's mothers, 10-20 times daily. How reliably this was performed is unproven. Trigger thumb severity was graded as 0A (extension beyond 0°), 0B (extension to 0°), 1 (active extension with triggering), 2 (passive extension with triggering), and 3 (cannot extend either actively or passively i.e. locked). At diagnosis, six of the 35 thumbs (17%) were grade 1, 25 (71%) were grade 2, and four (11%) were grade 3. After a mean follow-up period of 63 (range, 49-73) months, 28 thumbs (80%) were grade 0A or 0B, 5 (14%) were grade 1 and 2 (6%) were grade 2. The bilateral cases and the patients who initially had grade 3 severity had significantly more unfavorable results than the other patients. This study suggests that conservative treatment for pediatric trigger thumb is a successful method, although cases that present with bilateral involvement or locking (grade 3) should be considered for early surgical release.     

Basal joint osteoarthritis of the thumb: a prospective trial of steroid injection and splinting

PURPOSE: There have been few prospective studies evaluating the results of nonsurgical treatment of a well-defined patient cohort with symptomatic basal joint osteoarthritis of the thumb. This prospective study uses a validated outcome instrument to examine the effectiveness of a single steroid injection and 3 weeks of splinting in patients with osteoarthritis in Eaton stages 1 to 4 with a minimum of 18 months of follow-up evaluation. METHODS: Thirty consecutive patients (30 thumbs) were studied prospectively to evaluate the efficacy of a single injection of corticosteroid into the trapeziometacarpal joint, followed by immobilization in a thumb spica splint for 3 weeks. All patients answered an outcome-based questionnaire (Disabilities of the Arm, Shoulder, and Hand) and were examined before injection, 6 weeks after injection, and at final follow-up examination (minimum, 18 months). Eaton radiographic stage was recorded by 3 independent observers. RESULTS: At 6 weeks 13 patients had improvement in pain intensity and 17 patients reported no symptomatic improvement. Twelve of those with relief at 6 weeks continued to have relief at long term follow-up evaluation (mean, 25 months). Of patients with long-term relief average grip strength of the affected thumb was 95% of contralateral side, whereas those without relief had grip strength values that were 60% of contralateral side. For those patients without relief at 6 weeks there was no improvement seen at later follow-up evaluation. Five patients with Eaton stage 1 disease had an average of 23 months of relief with nonsurgical treatment. In stage 2 and stage 3 disease 7 thumbs improved at 6 weeks after injection and 6 thumbs had long-term relief. In stage 4 disease, 6 thumbs had neither short-term nor long-term relief with the injection. Disease side, handedness, and smoking did not affect outcomes. At final follow-up evaluation 12 thumbs had had surgical treatment. CONCLUSIONS: Steroid injection with splinting for the treatment of basal joint arthritis of the thumb provided reliable long-term relief in thumbs with Eaton stage 1 disease but provided long-term relief in only 7 of 17 thumbs with Eaton stage 2 and stage 3 basal joint arthritis.     

Mirror-image trigger thumb in dichorionic identical twins

The congenital vs acquired etiology of pediatric trigger thumb is the subject of considerable debate. Existing case reports of bilateral presentation in identical twins and first-degree familial association support the congenital hypothesis. However, prospective studies have yet to report a neonate presenting with this anomaly at birth. This article describes the first known set of dichorionic, monozygotic identical twins with unilateral trigger thumbs, affecting contralateral (mirror-image) hands and with asynchronous age at presentation (11 months and 18 months, respectively).Pediatric trigger thumb is caused by a mismatch between the flexor pollicis longus tendon and its A1 synovial pulley. Four sets of twins have been previously reported in the literature with trigger thumb. Of these, 3 sets were monozygotic twins who had bilaterally affected thumbs. Together with the absence of trauma, a congenital etiology was suggested. The fact that pediatric trigger thumb is generally seen several months after birth was felt to be due to infants holding their thumbs clutched in their palms until 6 months. However, no confirmed cases of trigger thumb have been diagnosed at birth in several large prospective studies of newborns.In the current case, the asynchronous presentation of unilateral trigger thumbs in identical twins does not support a solely congenital cause. Furthermore, the mirror-image presentation contradicts current embryological understanding of the temporal course of twinning and the determination of laterality. Thus, a multifactorial etiology is supported with both a genetic and acquired component affecting the development of this condition.     

Trigger thumb: results of a prospective randomised study of percutaneous release with steroid injection versus steroid injection alone

One hundred and twenty-seven trigger thumbs in 115 adult patients were randomised to either percutaneous release with steroid injection (n=66) or steroid injection alone (n=61). Two patients, one from each group, were lost to follow-up. Percutaneous release with steroid injection produced satisfactory results in 91% of cases whereas steroid injection alone produced satisfactory results in 47% of cases. One case in the percutaneous group developed stiffness and one in the injection group developed cellulitis. No digital nerve injury occurred in either group. We conclude that percutaneous trigger thumb release combined with steroid injection has a higher success rate than that of steroid injection alone.