Long-term outcomes of percutaneous release technique or open for trigger finger in diabetic patients

Yıl 2023, Cilt: 4 Sayı: 4, 323 - 328, 30.08.2023

Abdulrahim Dündar , Şehmuz Kaya , Deniz İpek

https://doi.org/10.47582/jompac.1327488

Öz

Aims: Trigger finger is seen more often in diabetic patients and can lead to more serious postoperative complications compared to non-diabetic patients. The aim of this study was to compare the outcomes of open and percutaneous release techniques in diabetic patients.
Methods: This retrospective study included 62 patients who met the study criteria. Of these patients, 32 underwent open release surgery and 30 underwent percutaneous release with an 18-gauge needle. The patients were evaluated retrospectively in respect of the data on first presentation preoperatively and at postoperative follow-up examinations at 3 weeks, 6 months and 1 year. A retrospective examination was made of the demographic data, Visual Analog Scale (VAS) scores preoperatively, at 6 and 12 months postoperatively, recurrence rates at the end of 6 months and 1 year, the Quinnell grading scale at the end of 1 year, wound site infection, tendon damage and neurovascular complications. VAS scores and the Quinnell grading scale were used for clinical evaluation.
Results: The data of a total of 62 patients were statistically analyzed in the study, with 32 (51.6%) in the Open group and 30 (48.4%) in the Percutaneous group. The mean age of the patients was 58.97±7.51 (min-max: 45-72) years. The distributions of trigger finger and Quinnell grading system scores were statistically similar between the groups (P=0.974, P=0.279, respectively). The recurrent triggering rate at the 6th and 12th month was significantly higher in the Percutaneous group (P=0.049, P=0.049, respectively). The average return to work duration in the Percutaneous group (1.70±0.75) was significantly shorter than that in the Open group (3.88±1.21) (P<0.001). Pre-op, Post-op 6th and 12th month VAS scores did not significantly differ between the groups (P=0.466, P=0.356, P=0.175, respectively).
Conclusion: Although satisfactory results were obtained with both percutaneous and open release techniques in the patients with diabetes in this study, the percutaneous release technique was seen to be a method which can be easily performed in an outpatient setting and had fewer complications.

Anahtar Kelimeler

Trigger finger, percutaneous, diabetic patients, open surgery, Quinnell grading

Diyabetik hastalarda tetik parmakta uygulanan perkütan gevşetme ve açık cerrahi tekniklerinin uzun dönem sonuçları

Öz

Giriş
Tetik parmak diyabetik hastalarda daha sık görülür ve diyabetik olmayan hastalara göre ameliyat sonrası daha ciddi komplikasyonlara yol açabilir. Bu çalışmanın amacı, diyabetik hastalarda açık ve perkütan gevşetme tekniklerinin sonuçlarını karşılaştırmaktır.
Gereç ve Yöntem
Bu retrospektif çalışmaya dahil edilme kriterlerini karşılayan 62 hasta alındı. Bu hastalardan 32'sine açık gevşetme cerrahisi, 30'una ise 18 ölçer iğne ile perkütan gevşetme uygulandı. Hastalar veriler açısından ameliyat öncesi ilk başvuru anında, postoperatif 3. hafta, 6. ay ve 1. yıl olmak üzere retrospektif olarak değerlendirildi.
Demografik veriler, ameliyat öncesi ve ameliyat sonrası 6. ve 12. aylarda Visuel Analog Skala (VAS) skorları, 6. ay ve 1. yıl sonunda nüks oranları, 1 yıl sonunda Quinnell derecelendirme ölçeği ve yara yeri enfeksiyonu, tendon hasarı ve nörovasküler komplikasyonlar retrospektif olarak incelendi. Klinik değerlendirmede VAS skorları ve Quinnell derecelendirme ölçeği kullanıldı.
Bulgular
Çalışmada 32'si (%51.6) açık grupta ve 30'u (%48.4) perkütan grupta olmak üzere toplam 62 hastanın verileri istatistiksel olarak analiz edildi. Hastaların yaş ortalaması 58.97±7.51 (min-max: 45-72) yıl idi. Tetik parmak ve Quinnell derecelendirme sistemi puanlarının dağılımları gruplar arasında istatistiksel olarak benzerdi (sırasıyla P=0.974, P=0.279). Perkütan grupta 6. ve 12. aylarda tekrarlayan tetikleme oranı anlamlı olarak daha yüksekti (sırasıyla P=0.049, P=0.049). Perkütan grupta (1.70±0.75) ortalama işe dönüş süresi açık gruptakilerden (3.88±1.21) anlamlı olarak daha kısaydı (P<0.001). Pre-op, Post-op 6. ve 12. ay VAS skorları gruplar arasında anlamlı farklılık göstermedi (sırasıyla P=0.466, P=0.356, P=0.175).
Sonuç
Bu çalışmada diyabetli hastalarda hem perkütan hem de açık gevşetme teknikleri ile tatmin edici sonuçlar elde edilmesine rağmen, perkütan salınım tekniğinin ayaktan tedavi ortamında kolaylıkla uygulanabilen ve daha az komplikasyonu olan bir yöntem olduğu görülmüştür.

Anahtar Kelimeler

tetik parmak, perkütan, diyabetik hasta, açık cerrahi, Quinnell ölçeği

Kaynakça

• Saremi H, Hakhamaneshi E, Rabiei MA:Percutaneous release of trigger fingers:comparing multiple digits with single digit involvement. Arch Bone J Surg. 2016;4:224-227.
• Bonnici AV, Spencer JD. A survey of ‘trigger finger’ in adults. J Hand Surg Br. 1988;13:202–203.
• Saldana MJ. Trigger digits:diagnosis and treatment. J Am Acad Orthop Surg. 2001;9(4):246-252.
• Paulius, K. L., and Maguina, P. Ultrasound-assisted percutaneous trigger finger release:is it safe? Hand (N Y). 2009;4:35–37.
• Hansen RL, Søndergaard M, Lange J. Open surgery versus ultrasound-guided corticosteroid injection for trigger finger:a randomized controlled trial with 1-year follow-up. J Hand Surg Am. 2017;42(5):359-366.
• Rojo-Manaute JM, Soto VL, De las Heras Sánchez- Heredero J, Del Valle Soto M, Del Cerro-Gutiérez M, Martín JV. Percutaneous intrasheath ultrasonographically guided first annular pulley release:anatomic study of a new technique. J Ultrasound Med. 2010;29(11):1517- 1529.
• Rajeswaran G, Lee JC, Eckersley R, Katsarma E, Healy JC. Ultrasound-guided percutaneous release of the annular pulley in trigger digit. Eur Radiol. 2009;19(9):2232- 2237.
• Abe Y. Clinical results of a percutaneous technique for trigger digit release using a 25-gauge hypodermic needle with corticosteroid infiltration. J Plast Reconstr Aesthet Surg. 2016;69(2):270-277.
• Bruijnzeel H, Neuhaus V, Fostvedt S, Jupiter JB, Mudgal CS, Ring DC. Adverse events of open A1 pulley release for idiopathic trigger finger. J Hand Surg Am. 2012;37:1650–1656.
• Will R, Lubahn J. Complications of open trigger finger release. J Hand Surg Am. 2010;35:594–559
• Slesarenko Y, Mallo G, Hurst L, Sampson S, Serra-Hsu F:Percutaneous release of A1 pulley. Tech Hand Up Extrem Surg. 2006;10:54-56.
• Kerrigan C, Stanwix M:Using evidence to minimize the cost of trigger finger care . J Hand Surg. 2009;34:997-1005.
• Elsayed MM:Percutaneous release of trigger finger. Egypt Orthop J. 2013;48:277-281.
• Huang HK, Wang JP, Wang ST, Liu YA, Huang YC, Liu CL:Outcomes and complications after percutaneous release for trigger digits in diabetic and non-diabetic patients. J Hand Surg. 2015, 40:735-739.
• Froimson AI. In: DP Green, editor. Operative hand surgery. 3rd ed. New York: Churchill Livingstone. (1993). p. 1995–1998.
• Fiorini HJ, Santos JB, Hirakawa CK, Sato ES, Faloppa F, Albertoni WM. Anatomical study of the A1 pulley:length and location by means of cutaneous landmarks on the palmar surface. J Hand Surg. 2011;36A:464–468.
• Sheikh E, Peters JD, Sayde W, Maltenfort M, Leinberry C:A prospective randomized trial comparing the effectiveness of one versus two (staged) corticosteroid injections for the treatment of stenosing tenosynovitis. Hand. 2014;9:340-345.
• Aksoy A, Sir E. Complications of percutaneous release of the trigger finger. Cureus. 2019;11:4132.
• Bain GI, Turnbull J, Charles MN, Roth JH, Richards RS:Percutaneous A1 pulley release:a cadaveric study. J Hand Surg Am. 1995;20:781-784.
• Mishra SR, Gaur AK, Choudhary MM, Ramesh J. Percutaneous A1 pulley release by the tip of a 20-g hypodermic needle before open surgical procedure in trigger finger management. Tech Hand Up Extrem Surg. 2013;17:112–5.
• Stahl S, Kanter Y, Karnielli E. Outcome of trigger finger treatment in diabetes. J Diabetes Complications. 1997;11(5):287–290
• Bruijnzeel H, Neuhaus V, Fostvedt S, Jupiter JB, Mudgal CS, Ring DC. Adverse events of open A1 pulley release for idiopathic trigger finger. J Hand Surg Am. 2012;37(8):1650–1656
• Gilberts EC, Beekman WH, Stevens HJ, Wereldsma JC. Prospective randomized trial of open versus percutaneous release for trigger digits. J Hand Surg. 2001;26A:497e500.