在保守治疗的同时调整导致症状加重的日常活动,对大多数患者均有效。在药物无效的病例中,手术治疗成功率极高。
扳机指
单纯夹板疗法对 55% 至 66% 的病例均有效。[3]Patel MR, Bassini L. Trigger fingers and thumb: when to splint, inject, or operate. J Hand Surg Am. 1992;17:110-113.http://www.ncbi.nlm.nih.gov/pubmed/1538090?tool=bestpractice.com[68]Rodgers WB, Waters PM. Incidence of trigger digits in newborns. J Hand Surg Am. 1994:19:364-368.http://www.ncbi.nlm.nih.gov/pubmed/8056959?tool=bestpractice.com皮质类固醇注射对 48% 至 93% 的病例有效。[6]Murphy D, Failla JM, Koniuch MP. Steroid versus placebo injection for trigger finger. J Hand Surg Am. 1995;20:628-631.http://www.ncbi.nlm.nih.gov/pubmed/7594291?tool=bestpractice.com[7]Newport ML, Lane LB, Stuchin SA. Treatment of trigger finger by steroid injection. J Hand Surg Am. 1990;15:748-750.http://www.ncbi.nlm.nih.gov/pubmed/2229972?tool=bestpractice.com[8]Rhoades CE, Gelberman RH, Manjarris JF. Stenosing tenosynovitis of the fingers and thumb: results of a prospective trial of steroid injection and splinting. Clin Orthop Relat Res. 1984;190:236-238.http://www.ncbi.nlm.nih.gov/pubmed/6488636?tool=bestpractice.com[23]Stahl S, Kanter Y, Karnielli E. Outcome of trigger finger treatment in diabetes. J Diabetes Complications. 1997;11:287-290.http://www.ncbi.nlm.nih.gov/pubmed/9334911?tool=bestpractice.com[37]Freiberg A, Mulholland RS, Levine R. Nonoperative treatment of trigger fingers and thumbs. J Hand Surg Am. 1989;14:553-558.http://www.ncbi.nlm.nih.gov/pubmed/2738345?tool=bestpractice.com[42]Griggs SM, Weiss AP, Lane LB, et al. Treatment of trigger finger in patients with diabetes mellitus. J Hand Surg Am. 1995;20:787-789.http://www.ncbi.nlm.nih.gov/pubmed/8522745?tool=bestpractice.com[43]Kolind-Sorensen V. Treatment of trigger fingers. Acta Orthop Scand. 1970;41:428-432.http://www.ncbi.nlm.nih.gov/pubmed/5537268?tool=bestpractice.com[44]Lapidus PW, Guidotti FP. Stenosing tenovaginitis of the wrist and fingers. Clin Orthop Relat Res. 1972;83:87-90.http://www.ncbi.nlm.nih.gov/pubmed/5014835?tool=bestpractice.com[45]Marks MR, Gunther SF. Efficacy of cortisone injection in treatment of trigger fingers and thumbs. J Hand Surg Am. 1989;14:722-727.http://www.ncbi.nlm.nih.gov/pubmed/2754207?tool=bestpractice.com据报道,经皮穿刺松解术对 58% 至 100% 病例有效。[47]Bain GI, Wallwork NA. Percutaneous A1 pulley release: a clinical study. Hand Surg. 1999;4:45-50.http://www.ncbi.nlm.nih.gov/pubmed/11089155?tool=bestpractice.com[48]Cihantimur B, Akin S, Ozcan M. Percutaneous treatment of trigger finger: 34 fingers followed 0.5-2 years. Acta Orthop Scand. 1998;69:167-168.http://www.ncbi.nlm.nih.gov/pubmed/9602776?tool=bestpractice.com[49]Eastwood DM, Gupta KJ, Johnson DP. Percutaneous release of the trigger finger: an office procedure. J Hand Surg Am. 1992;17:114-117.http://www.ncbi.nlm.nih.gov/pubmed/1538091?tool=bestpractice.com[50]Ha KI, Park MJ, Ha CW. Percutaneous release of trigger digits. J Bone Joint Surg Br. 2001;83:75-77.http://www.bjj.boneandjoint.org.uk/content/83-B/1/75.full.pdfhttp://www.ncbi.nlm.nih.gov/pubmed/11245542?tool=bestpractice.com[51]Lyu SR. Closed division of the flexor tendon sheath for trigger finger. J Bone Joint Surg Br. 1992;74:418-420.http://www.bjj.boneandjoint.org.uk/content/74-B/3/418.full.pdfhttp://www.ncbi.nlm.nih.gov/pubmed/1587893?tool=bestpractice.com[52]Pope DF, Wolfe SW. Safety and efficacy of percutaneous trigger finger release. J Hand Surg Am. 1995;20:280-283.http://www.ncbi.nlm.nih.gov/pubmed/7775770?tool=bestpractice.com[53]Stothard J, Kumar A. A safe percutaneous procedure for trigger finger release. J R Coll Surg Edinb. 1994;39:116-117.http://www.ncbi.nlm.nih.gov/pubmed/7520065?tool=bestpractice.com[54]Tanaka J, Muraji M, Negoro H, et al. Subcutaneous release of trigger thumb and fingers in 210 fingers. J Hand Surg Br. 1990;15:463-465.http://www.ncbi.nlm.nih.gov/pubmed/2269838?tool=bestpractice.com扳机指切开松解术仍是确定性治疗。
De Quervain 病
单纯夹板疗法疗效不佳。[69]Weiss AP, Akelman E, Tabatabai M. Treatment of de Quervain's disease. J Hand Surg Am. 1994;19:595-598.http://www.ncbi.nlm.nih.gov/pubmed/7963313?tool=bestpractice.com一次或两次皮质类固醇注射对 50% 至 80% 病例有效。[5]Harvey FJ, Harvey PM, Horsley MW. De Quervain's disease: surgical or nonsurgical treatment. J Hand Surg Am. 1990;15:83-87.http://www.ncbi.nlm.nih.gov/pubmed/2299173?tool=bestpractice.com[2]Lipscomb PR. Tenosynovitis of the hand and the wrist: carpal tunnel syndrome, de Quervain's disease, trigger digit. Clin Orthop. 1959;13:164-180.[22]Leao L. De Quervain's disease: a clinical and anatomical study. J Bone Joint Surg Am. 1958;40:1063-1070.http://www.ncbi.nlm.nih.gov/pubmed/13587574?tool=bestpractice.com[44]Lapidus PW, Guidotti FP. Stenosing tenovaginitis of the wrist and fingers. Clin Orthop Relat Res. 1972;83:87-90.http://www.ncbi.nlm.nih.gov/pubmed/5014835?tool=bestpractice.com[57]Ashraf MO, Devadoss VG. Systematic review and meta-analysis on steroid injection therapy for de Quervain's tenosynovitis in adults. Eur J Orthop Surg Traumatol. 2014;24:149-157.http://www.ncbi.nlm.nih.gov/pubmed/23412309?tool=bestpractice.com一项小型前瞻性研究显示,皮质类固醇注射联合夹板疗法比单纯注射有效。[58]Mardani-Kivi M, Karimi Mobarakeh M, Bahrami F, et al. Corticosteroid injection with or without thumb spica cast for de Quervain tenosynovitis. J Hand Surg Am. 2014;39:37-41.http://www.ncbi.nlm.nih.gov/pubmed/24315492?tool=bestpractice.com对于妊娠和哺乳期患者,非手术治疗非常有效;此病症通常会在终止哺乳后消退。[14]Avci S, Yilmaz C, Sayli U. Comparison of nonsurgical treatment measures for de Quervain's disease of pregnancy and lactation. J Hand Surg Am. 2002;27:322-324.http://www.ncbi.nlm.nih.gov/pubmed/11901392?tool=bestpractice.com[64]Schumacher HR Jr, Dorwart BB, Korzeniowski OM. Occurrence of De Quervain's tendinitis during pregnancy. Arch Intern Med. 1985;145:2083-2084.http://www.ncbi.nlm.nih.gov/pubmed/4062462?tool=bestpractice.com[65]Schned ES. De Quervain tenosynovitis in pregnant and postpartum women. Obstet Gynecol. 1986;68:411-414.http://www.ncbi.nlm.nih.gov/pubmed/3488531?tool=bestpractice.com对于药物无效病例,切开松解术是确定性治疗。此外,研究还报告过内窥镜下松解术。[63]Kang HJ, Koh IH, Jang JW, et al. Endoscopic versus open release in patients with de Quervain's tenosynovitis: a randomised trial. Bone Joint J. 2013;95-B:947-951.http://www.ncbi.nlm.nih.gov/pubmed/23814248?tool=bestpractice.com
其他所有腱鞘炎
在保守治疗的同时调整导致症状加重的日常活动,对大多数患者均有效。使用夹板疗法可有助于暂时固定或患者休息,尤其是在夜间。在药物无效的病例中,手术治疗成功率极高。