Percutaneous Release for Trigger Thumb in Children under General and Local Anesthesia

在全身麻醉及局部麻醉下經皮解離兒童的扳機拇指

王憲忠(Hsien-Chung Wang) ； 林高田(Gau-Tyan Lin)

《The Kaohsiung Journal of Medical Sciences》 20卷11期 (2004/11) Pp. 546-551

摘要

一追蹤自1989年二月至2003年三月，有三十三位平均2.5歲的兒童之四十隻扳機拇指，在不同麻醉方法（全身及局部麻醉）下，實施經皮解離手術治療的回朔性研究。依孩童及父母的忍受度　有二十個兒童門診時在局部麻醉下施行經皮解離手術。其他十三位孩童在全身麻醉下施行手術。當比較敏感的孩童及其父母必須施行全身麻醉時，我們推薦一特殊手法來確定A1滑車是否解離完全。在局部麻醉組中共有26隻扳機拇指，其中23隻成功解離。在全身麻醉組中，只有一個案例是不滿意的結果。經皮手術成功解離的兒童的扳機拇指高達90%。並且沒有復發的案例。經皮解離手術治療扳機拇指在不同麻醉方法下並沒有統計上的差異(P=0.66)。37隻扳機拇指在經皮解離手術後均能達到完全的主動伸直及主動屈取，並沒有遺留任何的畸形。我們的結果顯示不論何種麻醉下經皮解離手術治療兒童的扳機拇指有令人滿意的結果。

關鍵字

經皮解離 ； 扳機拇指 ； 局部麻醉 ； 全身麻醉

並列摘要

A retrospective trial of percutaneous release for 40 trigger thumbs in 33 children under different types of anesthesia (general versus local) at a mean age of 2.5 years was conducted between February 1989 and March 2003. Based on the tolerance of the child and parents, 20 children were processed using local anesthesia at our office and 13 children were given general anesthesia. We recommend special manipulation to ensure complete release of the Al pulley when general anesthesia is necessary. Of the 26 trigger thumbs in the local anesthesia group, 23 were successfully released. Only one patient in the general anesthesia group had an unsatisfactory outcome. Percutaneous surgery achieved a 90% successful release rate for trigger thumb in children, without recurrence. There was no statistical difference in the release of trigger thumbs with these two anesthetic procedures (р=0.66). Overall, 37 trigger thumbs achieved full extension and flexion without any residual deformity following percutaneous release. Our results suggest that percutaneous release for trigger thumb is satisfactory, no matter which method of anesthesia is used.

並列關鍵字

percutaneous release ； trigger thumb ； local anesthesia ； general anesthesia