儿童先天性拇指板机指13例报告

目的：探讨儿童先天性拇指扳机指的成因。病理改变；并对其进行分型，对治疗方法进行探讨。方法：静脉全麻下，对11例患儿行狭窄腱鞘部分切除术；2例加用肌腱成形术治疗，结果：全部病例经6个月-5年随访，均未复发，无术后粘连。结论：儿童先天性拇指扳机指绝大多数不能自愈。非手术治疗效果差。直视下的狭窄腱鞘部分切除术或加用肌腱成形术是目前较好的治疗方法。     

儿童先性拇指扳机指13例报告

目的探讨儿童先天性拇指板机指的成因,病理改变;并对其进行分型,对治疗方法先进探讨.方法静脉全麻下,对11例患儿行狭窄腱部分切徐术;2例加用肌腱成形术治疗.结果全部病例经6个月-5年随方,均未复发,无术后粘连.结论儿童先天性拇指板机指绝大多数不能自愈,非手术治疗效果差.直视下的狭窄腱部分切除术或加用肌腱成形术是目前较好的治疗方法.     

先天性扳机指手术治疗体会

目的探讨先天性扳机指的病理特点及疗效评价。方法对先天性扳机指患者行手术切除部分腱鞘,随访并分析疗效。结果本组7例先天性扳机指患者术后拇指伸屈运动均恢复正常,无复发病例,效果满意。结论先天性扳机指一旦经保守治疗无效,手术切除狭窄部部分腱鞘是一种迅速缓解症状、行之有效的治疗方式,术后复发率极低。     

手术治疗小儿屈指肌腱腱鞘炎

自1999年5月~2005年10月,采用腱鞘部分切除术及肌腱成形术治疗小儿手部屈指肌腱腱鞘炎53例,疗效满意。1临床资料1·1一般资料本组53例,男34例,女19例;年龄1~10岁,平均4岁。拇指38例,示指7例,中指5例,环指3例,其中包括两指或多指并发的5例。诊断标准:患指指间关节保持在固定的屈曲位,不能主动伸直手指或强迫伸直后很快又回到屈曲位,被动伸直手指有疼痛,掌指关节处可摸到增粗的肌腱,随手指屈伸上下活动,可有弹响,有时局部有压痛。全部病例均行手术治疗,其中35例行腱鞘部分切除术加肌腱成形术,18例只行腱鞘部分切除术,切除的腱鞘及变性的肌腱送…     

小儿先天性拇指扳机指手术并发症的防治

目的探讨降低小儿先天性拇指扳机指手术并发症的防治方法。方法通过对34例小儿扳机指行手术治疗，术中注意血管神经束的副损伤、适当处理肌腱硬结、彻底松解腱鞘及术后采取积极预防感染和肌腱粘连的措施，降低了手术并发症发生的。结果本组33例患儿经术后6～18个月随访，28例完全恢复正常，1例指间关节略屈曲，2例复发，2例出现患指指端麻木。结论对于小儿先天性拇指扳机指的治疗．通过术中和术后采取积极的措施可以明显降低手术并发症的发生。     

闭合性屈指肌腱腱鞘逆行切开治疗扳机指

采用闭合性屈指肌腱第一环形骨车逆行切开技术治疗扳机指７１例（８４指），其中儿童７例（７指），成人６４例（７７指），治愈率达９９％。详细介绍了闭合性屈指肌腱腱鞘逆行切开技术，认为屈指肌腱腱鞘闭合逆行切开术是手术扳机指的简单、安全、有效的方法。     

小儿先天性扳机指11例报告

小儿先大性扳机指较少见，主要病理表现是：腱鞘肥厚和肌腱梭形膨大。我院自1999年7月～2004年9月收治11例15手，行腱鞘部分切除术，治疗效果满意。     

先天性拇指疾病的疗效分析

目的：介绍先天性拇指疾病的治疗效果。方法：1988年起,对56例先天性拇多指畸形,先天性拇板机指及先天性拇巨指症进行手术治疗。采用拇指赘生指切除、副指皮瓣转移,多拇残端修整术治疗拇多指畸形;巨指截指及整形术治疗巨指症;增厚狭窄腱鞘切除术治疗先天性拇板机指。结果：术后随访2－10年。（1）先天性拇指多指畸形：主干拇指外形改善,拇外展充分,对指功能良好。（2）拇指板机指：拇指伸屈自如,发育满意。（3）先天性巨指症1例：示、中指巨指切除,拇指远节截除,近节缩短整形,术后外形欠佳。结论：先天性拇指多指畸形应根据具体情况选择手术方式,以改善畸形、恢复拇指功能。先天性板机指明确诊断手术疗效佳。先天性巨指症采用截指方法较为理想。     

儿童先天性扳机指

儿童先天性扳机指比较少见。我科１９８８－１９９３年共收治儿童先天性扳机指１７例，２１指。本组病例手术年龄为１－１０岁。手术方式的控制以切除增厚部分的腱鞘为最理想。手术后经０．５－３年随访无１例复发，效果满意。我们认为儿童先天性扳机指诊断一旦明确应及早手术。     

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     

Trigger digits in children

Seven thousand, seven hundred newborn children were examined prospectively to determine the congenital incidence of trigger thumb and finger. No cases were found. The case histories of 43 trigger digit cases (35 trigger thumbs and eight trigger fingers) noted in 40 children diagnosed at our center between 1995 and 1998 were reviewed with special reference to the spontaneous recovery rate, treatment outcome, and age at presentation. Of the 35 thumb cases, 23 underwent surgical release and all responded satisfactorily to surgical treatment. Spontaneous recovery was noted in 12 trigger thumb cases and in all eight trigger finger cases. Trigger finger developed earlier in life than trigger thumb and the spontaneous recovery rate was higher in trigger finger than trigger thumb.     

Trigger thumb in adults after hyperextension injury

Three cases of trigger thumb in adults developing after hyperextension injury are described. The similarity of the mode of injury in the cases and its possible role in the production of initial stenosis in the tendon sheath is discussed. Trauma alone may not cause triggering in the fingers, for there are other important factors such as rheumatoid disease, which with trauma may play a part. Trauma may however be the sole initiating factor in other cases of adult trigger thumbs.     

Incidence and development of trigger thumb in children

PURPOSE: Whether trigger thumb is congenital or acquired remains controversial. The purpose of this study was to identify whether trigger thumb is present at birth and to clarify whether trigger thumb represents a developmental condition. METHODS: We examined 1,116 babies born at Yamagata Prefectural Nihonkai Hospital within 14 days after birth. All patients were examined by the author (N.K.), a hand surgeon. Patients were followed up to determine whether trigger thumb would present later even though it was not present at birth. We informed parents about the development of trigger thumb by providing informational sheets for neonatal screenings after hospital discharge. They were asked to check their child for a year or more to see if any flexion deformity of the interphalangeal joint of the thumb occurred. After discharge from the hospital, the family was responsible for noticing trigger thumb in their infant and seeking medical treatment. RESULTS: Trigger thumb was not identified in any patient at birth. Responses were obtained from 601 families. Trigger thumb manifested in 2 thumbs of 2 children in the screening group at 8 and 11 months after birth; however, 3 additional children developed trigger thumb at 15, 21, and 30 months of age. CONCLUSIONS: The incidence of acquired trigger thumb in children 1 year of age was 3.3 per 1,000 live births. It is unlikely that this study identified all cases of trigger thumb in patients older than 1 year in the primary screening group. The results of this follow-up study, however, suggest that trigger thumb is not present at birth but develops with postnatal growth.     

Congenital trigger digit.

Release of the sheath of the flexor tendon is the accepted solution for the problem of congenital trigger digits in children. A series of 27 patients with 37 trigger digits were observed over a period of 18 years: the average follow-up on these patients was 46.9 months. Thirty-two thumbs, three long fingers, and two ring fingers showed locking and a degree of triggering. Thirty-three digits required surgery. The surgical treatment is simple and effective. The outcome in most cases shows that this is a conservative approach.     

The management of trigger thumb in children

Trigger thumb in children is an uncommon condition. We reviewed 41 patients with 53 trigger thumbs. Although the current accepted approach to the treatment of congenital trigger thumbs is a prolonged period of observation, our findings indicate that all of our patients eventually required surgical release of the flexor pollicis longus tendon. Waiting 3 years before a surgical release was done did not affect the surgical result.     

Risk stratification for the recurrence of trigger thumb after surgical release in the paediatric patient

Trigger thumb, or stenosing tenovaginitis, is a relatively uncommon condition affecting the flexor pollicis longus tendon of children. The condition is characterized by the formation of a nodule within the tendon and thickening of the tendon sheath as it passes through the flexor pulley of the thumb at the level of the metacarpo-phalangeal joint. The optimum age for surgical intervention continues to be discussed. The aim of this study is to establish the temporal relationship and surgical variables to determine factors that may contribute to recurrence of the condition. A retrospective analysis of the entire surgical logbook and patient notes of a stand-alone consultant paediatric orthopaedic practice was scrutinized. 94 patients, 107 thumbs, over a 13-year period were operated on for trigger thumb. The recurrence rate was found to be 5.61 %. The average age of patients at primary release who went on to recurrence was 2.8 years, which is significantly younger than those that did not recur (p = 0.044). Sensitivity analysis revealed that the primary procedure at an age of less than 2.5 years confers a higher risk of recurrence. The data presented here advocate surgical release of trigger thumb after 2½ years of age, a senior surgeon as lead operator and a transverse skin incision at the level of the nodule or a more extensive “zig-zag” one to clearly see the structures to be released. We recommend that the surgeon ensures the stenosing pulley and sheath are released in their entirety.     

Pollex flexus congenitus]

The authors report on the incidence, clinical picture, etiology, pathogenesis and treatment of congenital pollex flexus, and communicate the results of surgery on 52 thumbs. The permanent flexion anomaly in the interphalangeal joint and a hard, palpable knot in the long flexor tendon of the thumb over the metacarpophalangeal joint are typical for the deformity. Although these changes are sometimes observed immediately post partum, delayed diagnosis and treatment are more common. The hypothesis that it is a hereditary, endogenous condition is supported by observations in twins, relatively frequent bilateral occurrence and a high familial incidence. Constriction of the synovial sheath over the basal joint of the thumb is a key pathogenetic factor, although little is known about its causes; anatomical factors, influences affecting the growth of the sesamoid bones, and mechanical causes have been postulated. A more plausible hypothesis was first advanced by Jeannin. Like Hueston and Wilson 100 years later, he compared the tendon to a thick thread which had to be passed through a narrow eye of a needle: as a result, the "thread" would be frayed and compressed. The knot in the tendon is held to be a secondary phenomenon. The pathologicoanatomical picture varies. Lymphocyte and monocyte infiltration, and metaplasias to fiber cartilage have been detected in specimens excised from the tendon and the synovial sheath. However, pathologic changes have not been found in all cases. In the first year of life conservative therapy may be attempted, with temporary splinting of the thumb following manual correction of the flexion anomaly in the interphalangeal joint.(ABSTRACT TRUNCATED AT 250 WORDS)     

Trigger Wrist

Trigger wrist is a relatively rare disease compared to trigger finger, which is the most common disorder found in hands. Patients with trigger wrist usually complain about the following symptoms: snapping and clicking or triggering around carpal tunnel with or without mild to moderate median neuropathy. There are a total of five cases of trigger wrist: three cases of anomalous muscle belly of flexor digitorum superficialis and two cases of fibroma around flexor tendon sheath within carpal tunnel. This study reports on two of those cases: one with anomalous muscle and the other with fibroma of flexor tendon sheath. Accurate examination and proper diagnosis are mandatory to obviate improper and time-wasting treatment for patients with trigger wrist.     

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.