腱鞘松解治疗小儿先天性拇指扳机指
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摘要
目的探讨腱鞘松解术治疗小儿先天性拇指扳机指的远期疗效。方法回顾性分析2010年1月至2016年7月,采用手术松解腱鞘治疗21例儿童先天性扳机指患儿资料,男8例,女13例;年龄1岁1个月~6岁1个月,平均2岁8个月;单指17例(右手指10例,左手指7例),双指4例。术前拇指指间关节活动范围为(11.40±11.50)°,其中7例拇指指间关节嵌顿在屈曲位置;3例拇指被动可以伸直,很快屈曲,病情进行性加重,可触及肌腱摩擦感;5例拇指有弹响。掌指关节凸起并有压痛,压痛评分为(2.44±0.82)分。21例均采用手术松解腱鞘。结果 21例术后均获29~88个月随访,平均(54.4±19.4)个月。末次随访时,拇指指间关节活动范围及掌指关节处压痛评分分别为(80.20±10.31)°及(0.008±0.28)分,与术前相比,P均<0.05;1例残留偶有弹响,4例与健侧拇指相比,伸直轻度受限(-15°以下),16例嵌顿消失,屈伸正常同健侧。21例拇指外展、内收及对指对掌功能良好,屈肌肌力IV~V级;双手拇指发育对称。无一例出现神经血管损伤的并发症。结论早期手术松解可以矫正儿童先天性扳机指畸形,手指功能及外形发育正常,远期无肌力下降及继发畸形发生。
Objective To explore the long-term effects of tendon sheath release operation on infants with congenital thumb trigger. Methods Clinical data of 21 patients [ single thumb in 17 cases( right 10 cases, left 7 cases), double thumb 4 cases ] with congenital trigger thumb, treated by tendon sheath release operation from January 2010 to July 2016, were retrospectively analyzed. There were 8 boys and 13 girls with an average of 32 months( range: 13-73 months). The range of motion at the interphalangeal joint of the thumb was( 11.40 ± 11.50) ° before operation. Seven cases were fixed in the flexion position. The thumb can be passively straightened in 3 cases, but then buckled soon; progressive severe activity obstacle; tendon friction. Five cases were accompanied with clicking. The tenderness score of the metacarpophalangeal joints was( 2.44 ± 0.82) points. All patients underwent tendon sheath release. Results All 21 cases were followed up for 29-88 months with an average of( 54.4 ± 19.4) months. The range of motion at the interphalangeal joint of the thumb and tenderness score were( 80.20 ± 10.31) ° and( 0.008 ± 0.28) points respectively at the final follow-up. Compared with preoperative data, P < 0.05. One patient had occasional clicking. Four patients had straightening limitation( below-15°), compared with the contralateral thumb. Deformity disappeared in 16 patients with normal flexion and extension functions. All patients showed good abduction, adduction, motion and opposition. Muscle power of flexor was IV-V. Thumb development was symmetry. No neurological damage occurred. Conclusions Early tendon sheath release operation can correct congenital thumb trigger in infants. Finger functions and appearance return to normal without muscle weakness and secondary malformations.
Objective To explore the long-term effects of tendon sheath release operation on infants with congenital thumb trigger. Methods Clinical data of 21 patients [ single thumb in 17 cases( right 10 cases, left 7 cases), double thumb 4 cases ] with congenital trigger thumb, treated by tendon sheath release operation from January 2010 to July 2016, were retrospectively analyzed. There were 8 boys and 13 girls with an average of 32 months( range: 13-73 months). The range of motion at the interphalangeal joint of the thumb was( 11.40 ± 11.50) ° before operation. Seven cases were fixed in the flexion position. The thumb can be passively straightened in 3 cases, but then buckled soon; progressive severe activity obstacle; tendon friction. Five cases were accompanied with clicking. The tenderness score of the metacarpophalangeal joints was( 2.44 ± 0.82) points. All patients underwent tendon sheath release. Results All 21 cases were followed up for 29-88 months with an average of( 54.4 ± 19.4) months. The range of motion at the interphalangeal joint of the thumb and tenderness score were( 80.20 ± 10.31) ° and( 0.008 ± 0.28) points respectively at the final follow-up. Compared with preoperative data, P < 0.05. One patient had occasional clicking. Four patients had straightening limitation( below-15°), compared with the contralateral thumb. Deformity disappeared in 16 patients with normal flexion and extension functions. All patients showed good abduction, adduction, motion and opposition. Muscle power of flexor was IV-V. Thumb development was symmetry. No neurological damage occurred. Conclusions Early tendon sheath release operation can correct congenital thumb trigger in infants. Finger functions and appearance return to normal without muscle weakness and secondary malformations.
引文
[1]潘少川.实用小儿骨科学(3版)[M].北京:人民卫生出版社.2016:53.
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[4]成琦,杨文,周启星.矩形切除腱鞘治疗儿童扳机指[J].临床小儿外科杂志,2007,6(6):75-76.
[5]王春渤,何予馨,马世伟.小儿先天性拇指扳机指手术并发症的防治[J].实用手外科杂志,2011,25(2):129-130.
[6]张友乐,朱伟,孙燕琨,等.手指鞘管区异体滑膜肌腱与自体非滑膜肌腱移植的比较学研究[J].中华手外科杂志,2006,22(3):131-132.
[7]段洪,陈戈,张克强.儿童先天性拇指扳机指治疗结果的分析[J].中华手外科杂志,2002,18(4):199.
[8]姬树青,马信龙,马剑雄,等.短期激素局部注射治疗肌腱病的可行性研究[J].实用骨科杂志,2010,16(4):273-277,321.
[9]段大鹏,陈根元,萧文耀,等.氟喹诺酮类及糖皮质激素类药物对跟腱影响的细胞学观察[J].中国组织工程研究与临床康复,2008,12(33):6450-6452.
[10]傅明,姚伟邦,李佛保,等.局部注射糖皮质激素对运动员跟腱断裂的影响[J].中国运动医学杂志,2000,19(4):426-427.
[11]雷林革,沈美华,何如祥,等.自发性伸拇长肌腱断裂的临床诊治[J].实用骨科杂志,2012,18(1):78-80.
[2]彭裕文.局部解剖学(5版)[M].北京:人民卫生出版社.2001:224.
[3]朱云开,陈亚青,刘卫勇,等.小儿拇指扳机指超声表现的初步研究[J].中华医学超声杂志(电子版),2011,8(8):1759-1765.
[4]成琦,杨文,周启星.矩形切除腱鞘治疗儿童扳机指[J].临床小儿外科杂志,2007,6(6):75-76.
[5]王春渤,何予馨,马世伟.小儿先天性拇指扳机指手术并发症的防治[J].实用手外科杂志,2011,25(2):129-130.
[6]张友乐,朱伟,孙燕琨,等.手指鞘管区异体滑膜肌腱与自体非滑膜肌腱移植的比较学研究[J].中华手外科杂志,2006,22(3):131-132.
[7]段洪,陈戈,张克强.儿童先天性拇指扳机指治疗结果的分析[J].中华手外科杂志,2002,18(4):199.
[8]姬树青,马信龙,马剑雄,等.短期激素局部注射治疗肌腱病的可行性研究[J].实用骨科杂志,2010,16(4):273-277,321.
[9]段大鹏,陈根元,萧文耀,等.氟喹诺酮类及糖皮质激素类药物对跟腱影响的细胞学观察[J].中国组织工程研究与临床康复,2008,12(33):6450-6452.
[10]傅明,姚伟邦,李佛保,等.局部注射糖皮质激素对运动员跟腱断裂的影响[J].中国运动医学杂志,2000,19(4):426-427.
[11]雷林革,沈美华,何如祥,等.自发性伸拇长肌腱断裂的临床诊治[J].实用骨科杂志,2012,18(1):78-80.