超声引导下勾刀腱鞘松解术治疗小儿狭窄性腱鞘炎

Treatment of pediatric stenosing tenosynovitis with hook-knife under ultrasonic guidance

目的探讨B型超声引导下运用勾刀腱鞘松解术治疗小儿拇指狭窄性腱鞘炎的临床疗效。方法收集2017年6月至2020年6月在苏州大学附属无锡九院收治的58例小儿拇指狭窄性腱鞘炎患儿的相关资料。其中, 男33例, 女25例, 无拇指外伤史, 术前X线摄片排除骨关节疾病。根据随机数字法, 将患儿分成手术切开组(A组)及B型超声下勾刀切割组(B组)。A组患儿30例, 男19例, 女11例;年龄为(2.4±1.1)岁, 患侧为左侧16例, 右侧14例;B组患儿28例, 男14例, 女14例;年龄为(2.3±0.8)岁, 患侧为左侧16例, 右侧12例。A组患儿行腱鞘切开松解术, B组患儿行B型超声引导下勾刀腱鞘松解术。收集并对比观察两组患儿手术时间、术后疼痛评分、综合疗效及瘢痕情况。结果两组患儿手术均顺利完成, B组患儿切口小, 瘢痕程度轻, 早期疼痛改善明显;切口长度在B组为(1.9±0.8) mm, A组为(12.5±1.4) mm, 差异具有统计学意义(P<0.001);瘢痕情况评分在B组为(2.1±0.7)分, A组为(4.7±1.3)分, 差异具有统计学意义(P<0.001);术后1 d的疼痛评分在B组为(1.5±0.5)分, A组为(2.7±0.7)分, 差异具有统计学意义(P<0.001)。所有患儿均完成随访, 两组患儿末次随访均无复发, 疗效评定均为A级, 治疗有效率为100%, 术后复查B型超声均未见A1滑车处出现增生、粘连等情况, 肌腱滑动情况良好。结论 B型超声引导下勾刀腱鞘松解术治疗小儿拇指狭窄性腱鞘炎具有微创、瘢痕小、安全有效等优点, 适合临床推广。

Objective To explore the clinical efficacy of ultrasound-guided hook-knife tenosynovial release for stenosing tenosynovitis of thumb in children.Methods The relevant data were reviewed for 58 children with stenosing tenosynovitis of thumb from June 2017 to June 2020.There were 33 boys and 25 girls without any history of thumb trauma.They were randomized into surgical incision group(A,n=30)and B-mode ultrasonic cutting group(B,n=28).In group A,there were 19 boys and 11 girls aged(2.4±1.1)years.The involved side was left(n=16)and right(n=14);In group B,there were 14 boys and 14 girls aged(2.3±0.8)years.The involved side was left(n=16)and right(n=12).Group A underwent tenotomy and release while group B had B-mode ultrasound-guided hook-knife tenosynovial release.Operative duration,postoperative pain score,comprehensive efficacy and scar were compared between two groups.Results Both groups were successfully operated.The incision of group B was minimal with a mild scar was mild and early pain significantly improved;incision length was(1.9±0.8)mm in group B and(12.5±1.4)mm in group A.The difference had statistical significance(P<0.001);Scar score was(2.1±0.7)points in group B and(4.7±1.3)points in group A.The difference had statistical significance(P<0.001);Pain score at 1 d postoperatively was(1.5±0.5)points in group B and(2.7±0.7)points in group A.The difference had statistical significance(P<0.001).No recurrence was noted during follow-ups.The efficacy was evaluated as grade A with an effective rate of 100%.Postoperative ultrasonic reexamination showed no proliferation or adhesion at A1 trochlea with excellent tendon sliding.Conclusions For stenosing tenosynovitis of thumb in children,ultrasound-guided tendon sheath release with hook-knife offers the advantages of mini-invasiveness,minimal scar,greater safety and higher effectiveness.Wider popularization is worthwhile.