摘要
目的探讨手法矫正配合支具固定治疗儿童扳机拇的临床效果。方法回顾性分析2016年3月至2017年3月于苏州大学附属儿童医院就诊的52例(60指)扳机拇患儿临床资料。其中,男20例,女32例;8例患儿双侧发病,左侧30指,右侧30指;发现症状时患儿平均年龄为31.2个月,范围在14~72个月。所有患儿(60指)均接受手法矫正和支具固定,治疗分为第一阶段(8周)和第二阶段(6个月)。记录患儿一般资料、疾病分期、指间关节活动度、超声结果、治疗时间,统计治愈率和复发率。比较扳机拇不同分期之间治疗时间和效果的差异,比较不同年龄开始治疗的患儿治愈所需的时间差异,分析患指与健侧指肌腱和腱鞘厚度差值在治疗前后变化的差异。组间比较采用t检测或Mann-Whitney U检验或Wilcoxon秩和检验或卡方检验。结果60指平均治疗3.9个月后可主动伸直,治疗时间范围在0.1~19.0个月;其中59指(98%,59/60)平均治疗9.1个月后达到治愈标准,治疗时间范围在1~29个月。3例(3指,5%,3/60)患儿达到治愈标准后随访30个月内出现复发。SugimotoⅣ期1指(2%,1/60)因疼痛难忍于第一阶段治疗8周后终止治疗,治疗终止时患指已可主动伸直但不可主动屈曲。患儿开始治疗的年龄不同,患儿治愈所需的时间也不同,差异有统计学意义(自主伸直时间Z=-1.90,P=0.057,自主活动时间Z=-2.12,P=0.034)。SugimotoⅢ期开始治疗到可主动伸直的时间短于Ⅳ期,差异有统计学意义(Z=-3.10,P=0.002);Ⅲ期治愈时间短于Ⅳ期,差异有统计学意义(Z=-2.72,P=0.007)。达到治愈标准后,超声检查显示,41指患指与健侧比较,肌腱厚度差值小于治疗前,差值平均值为0.61 mm,范围在0~1.10 mm;腱鞘厚度差值小于治疗前,差值平均值为0.29 mm,范围在0~0.50 mm。结论规范细致的手法矫正配合调整后的支具固定治疗儿童扳机拇在临床上效果值得肯定,临床治愈率高,疾病复发率低,缩短了保守治疗的时间,解决了既往因支具固定造成拇指掌指关节半脱位的问题,解除了治疗过程中出现指间关节过伸位的"卡顿"现象。
Objective To explore the clinical efficacies of manual correction and brace fixation for pediatric trigger thumb(PTT).Methods From March 2016 to March 2017,the relevant clinical data were retrospectively reviewed for 52 PTT children(60 fingers).There were 20 boys and 32 girls.Involvement was unilateral(n=44)and bilateral(n=8).Sideness was left(30 fingers)and right(30 fingers).Mean onset age was 31.2(14-72)months.All 60 fingers were managed by manual correction and brace fixation.Treatment was offered for the first 8-week phase and the second 6-month phase.General profiles,disease stage,interphalangeal joint motion,ultrasonic results,treatment course,cure rate and recurrence rate were recorded.Treatment courses and outcomes of different stages,initiating treatment at different ages and differential thickness of tendon and tendon sheath between affected and healthy fingers before and after treatment were examined.Results All fingers could actively straighten after an average of 3.9 months.Treatment course was(0.1-19.0)months.And 59 fingers(98%,59/60)attained the standard of cure after an average of 9.1 months and treatment course was(1-29)months.Three children(3 fingers,5%,3/60)recurred within 30 months after fulfilling the cure criteria.One finger of Sugimoto stageⅣ(2%,1/60)withdrew at the end of phaseⅠdue to excruciating pain.The affected finger could actively extend but failed to actively bend.Ages of initiating treatment and curative courses differed.And the differences were statistically significant(autonomous straightening time:Z=-1.90,P=0.057;autonomous activity time:Z=-2.12,P=0.034).Time from initiating treatment to active straightening was shorter in Sugimoto stageⅢthan that in stageⅣand the difference was statistically significant(Z=-3.10,P=0.002).Time of autonomic activity was shorter in stageⅢthan that in stageⅣand the difference was statistically significant(Z=-2.72,P=0.007).After reaching the cure standard,ultrasound examination showed that the difference in tendon thickness between 41 affected fingers and the healthy side was smaller than before treatment,with an average difference of 0.61 mm,ranging from 0 to 1.10 mm;The difference in tendon sheath thickness is smaller than before treatment,with an average difference of 0.29 mm,ranging from 0 to 0.50 mm.Conclusions For PTT,clinical efficacy of standardized and meticulous manual correction and brace fixation is definite with a high curative rate,a low recurrence rate and a shorter course of conservative treatment.The problem of suluxation of thumb metacarpophalangeal joint caused by brace fixation has been resolved.And the phenomenon of"holding"caused by interphalangeal hyperextension during treatment is eliminated.
作者
孙钰涵
袁泉文
赵超晨
沈小芳
王晓东
Sun Yuhan;Yuan Quanwen;Zhao Chaochen;Shen Xiaofang;Wang Xiaodong(Department of Orthopedics,Affiliated Children's Hospital,Soochow University,Suzhou 215000,China;Department of Pediatric Surgery,Affiliated Shanghai Children's Hospital,School of Medicine,Shanghai Jiao Tong University,Shanghai 200062,China)
出处
《中华小儿外科杂志》
CSCD
北大核心
2024年第7期625-630,共6页
Chinese Journal of Pediatric Surgery
基金
学前儿童狭窄性腱鞘炎保守治疗临床研究与技术转化(P113100122)。
关键词
保守治疗
扳机拇
支具
肌腱
腱鞘
Conservative treatment
Trigger thumb
Brace
Muscle tendon
Tendinous sheath
