儿童扳机拇手术失败原因探讨及翻修术的疗效评估

Discussion on the causes of failure of trigger thumb surgery in children and evaluation of the clinical efficacy of revision surgery

目的探讨儿童扳机拇手术失败的原因,总结翻修术的技术细节并评估治疗效果。方法自2016年1月至2018年12月,我们对6例(8指)扳机拇术后症状复发或加重的患儿进行翻修术,术中观察拇长屈肌腱卡压状态及指间关节屈伸活动,术后随访患儿临床症状的改善情况,总结儿童扳机拇手术失败的原因和翻修术的技术细节,评估临床疗效。结果屈肌腱卡压因素解除不彻底、指间关节关节囊挛缩是导致手术失败的主要原因,术后康复锻炼方法不当、瘢痕粘连也是一部分原因,指间关节长期屈曲畸形会导致拇长屈肌腱动力不足。术后经过2年以上的随访,患儿拇指指间关节屈伸活动度较术前改善,根据中华医学会手外科功能评定标准评定:优1例(1指)、良4例(6指)、可1例(1指)。结论一期手术对指间关节屈伸活动异常矫正不彻底、术后屈伸功能锻炼不合适、瘢痕粘连是儿童扳机拇复发的原因,儿童扳机拇翻修术治疗效果不佳,因此一期有效松解、合适的康复锻炼非常重要。

Objective To explore the reasons for the failure of trigger thumb surgery in children,summarize the technical details of revision surgery and evaluate the clinical efficacy.Methods From January 2016 to December 2018,we performed revision surgery on 6 children(8 fingers)with recurrent or aggravated symptoms after trigger thumb surgery.During the operation,we observed the compression state of flexor pollicis longus tendon and the flexion and extension activity of interphalangeal joint.After the operation,we followed up the improvement of children′s clinical symptoms,summarized the causes of failure of trigger thumb surgery and the technical details of revision surgery,and evaluated the clinical efficacy.Results The incomplete release of flexor tendon compression factors and interphalangeal joint capsule contracture were the main reasons for the failure of the operation.The improper postoperative rehabilitation exercise and scar adhesion were also some reasons.The long-term flexion deformity of interphalangeal joint would lead to the lack of power of flexor pollicis longus tendon.After more than 2 years of follow-up,the flexion and extension range of the interphalangeal joint of the thumb was improved compared with that before operation.According to the evaluation standard of hand surgery function issued by the Chinese Medical Association,it was excellent in 1 case(1 finger),good in 4 cases(6 fingers)and fair in 1 case(1 finger).Conclusion The incomplete correction of abnormal flexion and extension activities of interphalangeal joint in one-stage operation,inappropriate postoperative flexion and extension function exercise and scar adhesion are the reasons for the recurrence of trigger thumb in children.The treatment effect of revision of trigger thumb in children is not good.Therefore,it is very important to effectively release and appropriate rehabilitation exercise in one-stage operation.