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。

Percutaneous release of trigger finger with L shaped hollow needle knife

Objective To investigate the effectiveness of a percutaneous release with L shaped hollow needle knife in treating trigger finger.Methods Between September 2007 and September 2009,160 patients with trigger fingers(202 fingers) were treated by percutaneous release with L shaped hollow needle knife.There were 47 males and 113 females with a mean age of 55 years(range,12-68 years).The disease duration was 2 weeks to 1 year.Affected fingers included 58 thumbs,20 index fingers,46 middle fingers,60 ring fingers,and 18 little fingers.According to Quinnell grading,63 fingers were classified as grade III,126 fingers as grade IV,and 13 fingers as grade V.A1 pulley was released during operation and steroid was injected after release procedure using the same needle.Results The mean operation time was 8.2 minutes(range,5-19 minutes),and no complication occurred.All the patients were followed up 1 year to 3 years and 6 months(mean,1.6 years).The patients still felt pain in 36 fingers at 1 week after operation,which were relieved after oral administration of non-steroidal anti-inflammatory drug.Twenty-five fingers had snapping or locking in flexion-extension motion;5 fingers recovered at 1 month after operation and 20 fingers had no obvious improvement;of 20 fingers,symptom was alleviated in 10 fingers,and was not alleviated in 10 fingers after re-release with L shaped hollow needle knife.According to Quinnell grading for efficacy evaluation at 6 months after operation,the results were excellent in 165 fingers,good in 27 fingers,poor in 10 fingers with an excellent and good rate of 95.0%.Conclusion The percutaneous release with L shaped hollow needle knife is a safe and effective procedure in treating trigger finger with low complications.