방아쇠 무지의 A1 활차 절개술 후 활줄현상에 대한 전향적 연구 = A Prospective Study of Bowstringing after A1 Pulley Release of Trigger Thumb: Percutaneous versus Open Technique

다국어 초록 (Multilingual Abstract)

Purpose: In the treatment of trigger thumb, inadequate or excessive release of the flexor pulley can lead to secondary complications such as bowstringing. However, few studies detailed bowstringing after surgical release of the A1 pulley for trigger thumb and its influence on hand function.The purpose of this study was to determine the extent to which the release of the A1 pulley causes bowstringing in the treatment of trigger thumb, and how the percutaneous technique is beneficial to bowstringing and clinical function over open technique.
Methods: The author prospectively reviewed 31 patients with resistant trigger thumb who were randomized to undergo either percutaneous release (17 patients) or open release (14 patients) of the A1 pulley. We quantified bowstringing of the thumb using ultrasonography at 12 and 24 weeks after surgery. Clinical outcomes were analyzed to correlate with the ultrasonographic measurements.
Results: Each cohort showed a significant improvement in all clinical outcomes (p<0.05), with no difference between the groups at each follow-up (p>0.05). The bowstringing was greater increased at 12 weeks after surgery in both groups compared to before surgery (5.71±1.04 mm vs. 5.20±0.79 mm, p=0.039). However, the difference of those values was not significant at 24 weeks’ follow-up (5.02±0.71 mm vs. 4.86±0.33 mm, p=0.671) There was no significant correlation between the bowstringing and any clinical outcome measures (p>0.271).
Conclusion: Open A1 pulley release caused greater bowstringing than percutaneous technique at initial after surgery. However, bowstringing did not affect clinical hand function in patients treated with either percutaneous or open technique.

참고문헌 (Reference)

1 박광희, "초음파를 이용한 방아쇠 무지의 경피적 절개술" 대한수부외과학회 21 (21): 218-224, 2016

2 Sato ES, "Treatment of trigger finger: randomized clinical trial comparing the methods of corticosteroid injection, percutaneous release and open surgery" 51 : 93-99, 2012

3 Leeflang S, "The role of proximal pulleys in preventing tendon bowstringing: pulley rupture and tendon bowstringing" 67 : 822-827, 2014

4 Bayat A, "The pulley system of the thumb: anatomic and biomechanical study" 27 : 628-635, 2002

5 Low CK, "The effect of the extent of A1 pulley release on the force required to flex the digits. A cadaver study on the thumb, middle and ring fingers" 23 : 46-49, 1998

6 Jou IM, "Sonographically assisted percutaneous release of the a1 pulley: a new surgical technique for treating trigger digit" 31 : 191-199, 2006

7 Gilberts EC, "Prospective randomized trial of open versus percutaneous surgery for trigger digits" 26 : 497-500, 2001

8 Fowler JR, "Percutaneous trigger finger release" 38 : 2005-2008, 2013

9 Wang J, "Percutaneous release, open surgery, or corticosteroid injection, which is the best treatment method for trigger digits?" 471 : 1879-1886, 2013

10 Ha KI, "Percutaneous release of trigger digits" 83 : 75-77, 2001

11 Cebesoy O, "Percutaneous release of the trigger thumb: is it safe, cheap and effective?" 31 : 345-349, 2007

12 Manske PR, "Palmar aponeurosis pulley" 8 : 259-263, 1983

13 Dierks U, "Open versus percutaneous release of the A1-pulley for stenosing tendovaginitis: a prospective randomized trial" 12 : 183-187, 2008

14 Guler F, "Open versus percutaneous release for the treatment of trigger thumb" 36 : e1290-e1294, 2013

15 Lin GT, "Mechanical properties of human pulleys" 15 : 429-434, 1990

16 Kuo LC, "Kinematical and functional improvements of trigger digits after sonographically assisted percutaneous release of the A1 pulley" 27 : 891-896, 2009

17 Tavares WC Jr, "Healing of the Achilles tendon in rabbits--evaluation by magnetic resonance imaging and histopathology" 9 : 132-, 2014

18 Crosby CA, "Hand strength: normative values" 19 : 665-670, 1994

19 Lin GT, "Functional anatomy of the human digital flexor pulley system" 14 : 949-956, 1989

20 Mitsionis G, "Feasibility of partial A2 and A4 pulley excision: effect on finger flexor tendon biomechanics" 24 : 310-314, 1999

21 Peterson WW, "Effect of pulley excision on flexor tendon biomechanics" 4 : 96-101, 1986

22 Hudak PL, "Development of an upper extremity outcome measure: the DASH (disabilities of the arm, shoulder and hand) [corrected]. The Upper Extremity Collaborative Group (UECG)" 29 : 602-608, 1996

23 Cecen GS, "Corticosteroid injection for trigger finger: blinded or ultrasound-guided injection?" 135 : 125-131, 2015

24 Quinnell RC, "Conservative management of trigger finger" 224 : 187-190, 1980

25 Will R, "Complications of open trigger finger release" 35 : 594-596, 2010

26 Heithoff SJ, "Bowstringing as a complication of trigger finger release" 13 : 567-570, 1988

27 Parellada JA, "Bowstring injury of the flexor tendon pulley system: MR imaging" 167 : 347-349, 1996

28 Calleja H, "Anatomic outcome of percutaneous release among patients with trigger finger" 35 : 1671-1674, 2010