环线切割治疗小儿拇指狭窄性腱鞘炎临床观察

Clinical observation of percutaneously looped thread transection in the surgical treatment of congenital trigger thumb( CTT )

目的探讨环线切割微创技术治疗小儿拇指先天狭窄性腱鞘炎（congenital trigger thumb,CTT）手术效果。方法 2013年3月至2014年9月,我科收治小儿拇指A1滑车CTT患儿19例（31侧）,均在超声引导下通过环线切割微创技术进行拇长屈肌腱狭窄腱鞘的松解。对患儿术前、术后进行Quinnell分级进行评估,并通过配对t检验进行统计学分析。结果环线切割微创技术创伤小,出血少,术后无穿刺点感染、愈合不良、血管神经损伤等情况发生,术后患儿均在3~7天内恢复正常手指功能,拇指主、被动伸直活动28侧完全正常,局部无疼痛症状,术后随访12~30个月未见复发。2侧症状有所缓解,仅1侧基本无缓解,治疗有效率96.7%。Quinnell分级表评分术前3.48±0.54、术后0.39±0.73,术前、术后差异有统计学意义（P〈0.05）。结论环线切割微创技术可作为小儿CTT治疗安全、有效的治疗方法。

Objective To study the effects of percutaneously looped thread transection in the surgical treatment of congenital trigger thumb（ CTT）. Methods Nineteen children with CTT（ 31 sides） were enrolled and treated in our department from March 2013 to September 2014. All the surgeries were conducted by percutaneously looped thread transection to release the narrowness of long hallux flexor tendon sheath under ultrasound. All the children were evaluated by preoperative and postoperative Quinnell classification and the statistical analysis was performed by the Paired T test. Results Percutaneously looped thread transection was micro-invasive and less bleeding. Postoperative puncture point infection, poor healing, vascular and nerve injury had not been found. All the children recovered to normal within 3 to 7 days after the operation. The thumb initiative and passive activities of 28 sides were completely normal. No local pain or recurrence was found in 12- 30 months＇ follow-up. Symptoms of 2 sides were relieved. Only 1 had no response. The effective rate was 96.7%. The scores of preoperative and postoperative Quinnell classification were 3.48 ± 0.54 and 0.39 ± 0.73 respectively. The P value was 0 and the differences were statistically significant（ P〈0.05）. Conclusions The looped thread transection is a safe and effective method in the treatment of children＇s CTT.