小切口手术松解对小儿先天性拇指狭窄性腱鞘炎手指捏力的影响

Effect of small-incision untethering surgery on pinching force of finger in children with congenital stenosing tenovaginitis of the thumb

目的探讨小切口手术松解治疗小儿Quinnell分级Ⅲ~Ⅳ级先天性拇指狭窄性腱鞘炎的效果及对手指捏力的影响。方法回顾性分析2016年1月至2020年3月遵义医科大学附属医院收治的272例先天性拇指狭窄性腱鞘炎患儿的临床诊治资料,将2016年1月至2018年2月接受传统外科手术治疗的130例患儿纳入传统组,2018年3月至2020年3月接受小切口手术松解治疗的142例患儿纳入小切口组,比较两组患儿围术期指标。随访3个月,比较两组患儿患指关节总主动活动度(TAM)、腱鞘厚度、手指捏力、临床疗效及并发症发生情况。结果小切口组患儿的手术时间、住院时间和患指功能恢复时间分别为(32.28±4.41)min、(4.15±1.07)d、(21.06±3.44)d,明显短(快)于传统组的(45.18±6.37)min、(7.28±2.10)d、(30.17±4.62)d,而术中失血量为(1.47±0.34)mL,明显少于传统组的(2.62±0.31)mL,差异均具有统计学意义(P<0.05)。术后3个月,两组患儿的腱鞘厚度均变薄,且小切口组为(0.45±0.10)mm,明显薄于传统组的(0.60±0.08)mm,差异具有统计学意义(P<0.05);术后3个月,两组患儿的手指捏力均增大,且小切口组为(7.15±1.28)磅,明显大于传统组的(6.64±1.13)磅,差异具有统计学意义(P<0.05);术后3个月,小切口组患儿的TAM优良率、临床有效率分别为83.10%、91.55%,明显高于传统组68.46%、80.00%,并发症发生率为5.64%,明显低于传统组的17.70%,差异均具有统计学意义(P<0.05)。结论小切口手术松解治疗小儿Quinnell分级Ⅲ~Ⅳ级先天性拇指狭窄性腱鞘炎具有操作简便、术后恢复快等优势,可有效提高患儿手指捏力,改善指关节活动度,临床疗效确切。

Objective To explore the effect of small-incision untethering surgery in the treatment of children with congenital stenosing tenosynovitis of the thumb of Quinnell gradeⅢ-Ⅳand its influence on the pinching force of the fingers.Methods The clinical diagnosis and treatment data of 272 children with congenital stenosing tenosynovitis of the thumb admitted to the Affiliated Hospital of Zunyi Medical University from January 2016 to March 2020 were retrospectively analyzed.Among the 272 children,130 who received traditional surgical treatment from January 2016 to February 2018 were included in the traditional group,and 142 who received small-incision untethering surgery from March 2018 to March 2020 were included in the small-incision group.The perioperative indicators between the two groups were compared.The patients were followed up for 3 months,and the total active movement(TAM),ten-don sheath thickness,pinching force of finger,clinical efficacy,and complications of the two groups were compared.Results The operation time,length of hospital stay,and recovery time of finger function in the small-incision group were(32.28±4.41)min,(4.15±1.07)d,(21.06±3.44)d,respectively,which were significantly shorter(faster)than(45.18±6.37)min,(7.28±2.10)d,(30.17±4.62)d in the traditional group,and the intraoperative blood loss was(1.47±0.34)mL,significantly lower than(2.62±0.31)mL of the traditional group(P<0.05).At three months after operation,the thickness of tendon sheaths in both groups became thinner,and that of the small-incision group was(0.45±0.10)mm,which was significantly thinner than(0.60±0.08)mm of the traditional group(P<0.05);at three months after operation,the pinching force of finger the two groups increased,and that of the small-incision group was(7.15±1.28)pounds,which was signifi-cantly greater than(6.64±1.13)pounds of the traditional group(P<0.05);at three months after operation,the excellent and good rate and clinical effective rate of TAM in the small-incision group were 83.10%and 91.55%,respectively,which were significantly higher than 68.46%and 80.00%in the traditional group,and the complication rate was 5.64%,significantly lower than 17.70%in the traditional group(P<0.05).Conclution Small-incision untethering surgery has the advantages of simple operation and quick postoperative recovery in the treatment of congenital stenosing tenosynovi-tis of the thumb of Quinnell gradeⅢ-Ⅳ.It can effectively improve the pinching force of the children's fingers and im-prove the mobility of the knuckles,and the clinical effect is definite.