Small incision tendinolysis under local anesthesia for 949 cases of pediatric stenosing tenovaginitis of thumb_West China Medical Journal

Authors：

WANG Daoxi , LIU Lijun , YANG Xiaodong , YANG Panyi ,  JIANG Xin

Department of Pediatric Surgery, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, P. R. China;

Corresponding author：

JIANG Xin, Email: jiangxin1975@126.com

Keywords：

Children; stenosing tenovaginitis of thumb; local anesthesia; minimally invasive surgery

DOI：

10.7507/1002-0179.202308196

Video：

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Objective To investigate the therapeutic effect of minimally invasive small incision surgery under local anesthesia for pediatric stenosing tenovaginitis of thumb. Methods A retrospective analysis was conducted on the medical records of children with stenosing tenovaginitis of thumb who received small incision tendinolysis under local anesthesia at West China Hospital of Sichuan University between January 2013 and August 2022, to evaluate and analyze the safety and effectiveness of the surgery. Results A total of 949 pediatric patients were included, with an average age of (3.23±1.92) years. The average duration of surgery was (7.0±2.5) minutes, and the average follow-up time was (3.91±5.32) months. All patients did not need to fast for solids and liquids before surgery, and were immediately discharged from the hospital after outpatient surgery. The family members of the patients were highly satisfied with the treatment process and postoperative recovery. All patients had no nerve or vascular damage, and the wound margin skin showed linear healing with mild scars that fused with palm prints. There were 825 cases (86.93%) of children with thumb function fully restored to normal, 113 cases (11.91%) with limited maximum dorsiflexion function of the thumb, and 11 cases (1.16%) with recurrent stiffness of the thumb metacarpophalangeal joint. Conclusion Small incision tendinolysis under local anesthesia is a safe and effective treatment for pediatric stenosing tenovaginitis of thumb, with high satisfaction among the patients’ family members.

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15.	李春叶, 张倩, 王华, 等. 超声引导下不同型号针刀联合复方倍他米松注射液治疗扳机指的疗效对比. 江苏大学学报(医学版), 2024, 34(3): 248-253.
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1. 孙宁, 郑珊, 冯杰雄, 等. 小儿外科学. 北京: 人民卫生出版社, 2015: 311-313.
2. 吴煌超, 孙劲, 张忠文. 指屈肌腱狭窄性腱鞘炎治疗的研究进展. 中国医药导报, 2024, 21(1): 68-71.
3. Choi S, Lim H, Ha C, et al. Prevalence and characteristics by age and sex in pediatric trigger digits: nationwide analysis using Korea health insurance dataset. Clin Orthop Surg, 2024, 16(4): 650-660.
4. Hudock NL, Girgis MW, Glaun GD, et al. Paediatric trigger thumb: diagnostic pearls. J Paediatr Child Health, 2024, 60(11): 680-683.
5. Lin JS, Pettit R, Rosenbaum JA, et al. The development of trigger thumb in the contralateral thumb in pediatric patients presenting initially with unilateral involvement. Hand (N Y), 2021, 16(3): 316-320.
6. Venkatadass K, Bhardwaj P, Sabapathy SR. Pediatric trigger thumb: congenital or developmental? A unique case report. J Hand Microsurg, 2020, 12(Suppl 1): S75-S77.
7. 杨晓颜, 杜青, 周璇, 等. 中西医结合治疗小儿拇指扳机指的临床疗效. 教育生物学杂志, 2022, 10(2): 93-97.
8. 陈柏华, 罗军, 熊祎玭, 等. 超声引导下扳机指针刀松解的临床价值. 中国超声医学杂志, 2021, 37(4): 456-459.
9. Swanson AB, Hagert CG, Swanson GD. Evaluation of impairment of hand function. J Hand Surg Am, 1983, 8(5): 709-722.
10. 蒋良福, 周飞亚, 李志杰, 等. 儿童拇指扳机指局部封闭治疗的疗效分析. 中华手外科杂志, 2010, 26(6): 332-334.
11. Wolfe SW, Hotchkiss RN, Pederson WC, et al. Green’s operative hand surgery. 7th ed. Philadelphia PA: Elsevier, 2017: 1320-1322.
12. 李伟笠, 刘方娜, 李振威, 等. 腱鞘松解术治疗儿童扳机指 487 例疗效分析. 河南外科学杂志, 2022, 28(2): 65-67.
13. 罗涛, 刘景. 微创松解疗法治疗指屈肌腱狭窄性腱鞘炎研究. 中国骨伤, 2013, 26(5): 438-440.
14. 屈亮, 胡迪, 吴夏勃, 等. 钩刀松解法治疗屈指肌腱狭窄性腱鞘炎的病例对照研究. 中国骨伤, 2010, 23(12): 942-944.
15. 李春叶, 张倩, 王华, 等. 超声引导下不同型号针刀联合复方倍他米松注射液治疗扳机指的疗效对比. 江苏大学学报(医学版), 2024, 34(3): 248-253.
16. 张良. 局麻药物丁卡因与利多卡因在鼻内镜中的疗效比较. 继续医学教育, 2016, 30(4): 152-155.
17. Wang B, Qi R, Gu J, et al. Efficacy analysis of three kinds of surgery for trigger thumb. Int Orthop, 2022, 46(12): 2853-2857.
18. Edwards DS, Richards RH. Risk stratification for the recurrence of trigger thumb after surgical release in the paediatric patient. Eur J Orthop Surg Traumatol, 2016, 26(6): 587-590.
19. Fiorini HJ, Tamaoki MJ, Lenza M, et al. Surgery for trigger finger. Cochrane Database Syst Rev, 2018, 2(2): CD009860.
20. Shah AS, Bae DS. Management of pediatric trigger thumb and trigger finger. J Am Acad Orthop Surg, 2012, 20(4): 206-213.

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