A1滑车松解术治疗儿童"伸直型"扳机拇的效果分析  

Causes and surgical outcomes of pediatric extension trigger thumb

作　　者：徐蕴岚[1] 章燕云 韩炳强[1] Xu Yunlan;Zhang Yanyun;Han Bingqiang(National Children's Medical Center,Department of Pediatric Orthopedics,Shanghai Children's Medical Center,School of Medicine,Shanghai Jiao Tong University,Shanghai 200127,China;National Children's Medical Center,Department of Anesthesiology,Shanghai Children's Medical Center,School of Medicine,Shanghai Jiao Tong University,Shanghai 200127,China)

机构地区：[1]国家儿童医学中心,上海交通大学医学院附属上海儿童医学中心骨科,上海200127 [2]国家儿童医学中心,上海交通大学医学院附属上海儿童医学中心麻醉科,上海200127

出　　处：《中华小儿外科杂志》2023年第7期636-640,共5页Chinese Journal of Pediatric Surgery

基　　金：上海市科学技术委员会上海市自然科学基金(20ZR1434800)。

摘　　要：目的总结A1滑车松解术治疗儿童罕见的"伸直型"扳机拇的手术效果。方法回顾性分析2014年1月至2019年12月就诊于上海市儿童医学中心随访时间大于18个月的25例"伸直型"扳机拇患儿的临床资料。其中男14例,女11例。患儿手术时的平均年龄为4.3岁,范围在2~8岁。患侧拇指位于左侧13例,右侧9例,双侧3例;共计28只拇指受累。统计患儿是否接受过固定屈曲扳机拇的非手术治疗。所有患儿均接受A1滑车松解术和患拇滑车的部分切除术,记录并分析患儿术前、术后即时、术后末次随访拇指指间关节活动范围。计量资料的比较采用配对t检验。结果72%(18/25)的患儿接受过固定屈曲扳机拇指的非手术治疗。所有患儿均顺利接受A1松解手术,所有患儿手术前指间关节主动屈曲为(25.2±5.4)°,术后即时指间关节主动屈曲为(59.8±6.8)°,末次随访时为(68.8±4.7)°。与手术前比较,术后即时指间关节主动屈曲改善34.7°(t=-27.92,P<0.001),末次随访时指间关节主动屈曲改善43.6°(t=-43.40,P<0.001)。对于单侧受影响的患儿,末次随访时拇指指间关节主动屈曲活动度较术前明显改善(25.5°比68.5°,t=-41.67,P<0.001),但没有达到与健侧拇指最大屈曲活动水平。结论"伸直型"扳机拇是临床罕见的扳机拇,临床上易漏诊。A1滑车松解术可有效改善拇指指间关节屈曲功能。Objective To introduce the rare clinical manifestations,possible causes and surgical outcomes of extension trigger thumb(ETT)in children.Methods Clinical data were retrospectively reviewed for 25 ETT children operated from 2014 to 2019 and followed up for over 18 months.Basic profiles and active/passive range of motion of interphalangeal joint of the thumb were recorded before,during and after the last follow-up.Results A total of 28 thumbs were diagnosed as ETT and 3 children had an involvement of both thumbs.Among them,18(72%)children had a history of non-surgical treatment of fixed flexion trigger thumb.The average active flexion of interphalangeal joint(IPJ)was 25.2°preoperatively,59.8°after A1 pulley release(t=-27.92,P<0.001)and 68.8°at the last follow-up(t=-43.40,P<0.001).For children with a unilateral involvement,active flexion activity of IPJ of thumb significantly improved(25.5°vs 68.5°,t=-41.67,P<0.001).However,it failed to attain the maximal flexion activity level of healthy thumb.Conclusions ETT is a rare clinical sign and it is easily misdiagnosed clinically.Releasing A1 pulley may also effectively improve the flexion function of IPJ of thumb.

关 键 词：扳机指症 手术 疗效 儿童 

分 类 号：R726.8[医药卫生—儿科]