原來板機指可以不用開刀系列1

-- 小針刀治療板機指有效嗎?

案例:

小針刀成功治療案例: 女性，50歲，板機指，小針刀治療後，手指旋即恢復機能。

查實證醫學，給各位參考

板機指治療種類: 經痛劑常用共四種。

@類固醇注射 (Steroid injection)

類固醇注射到腱鞘內，可減少腱鞘腫脹，成功率: 50-70%。

It's estimated that corticosteroid injections are an effective treatment for 50 to 70% of people with trigger finger. However, they're generally less effective in people with certain underlying health conditions, such as diabetes and rheumatoid arthritis.

NHS treatment trigger figner

https://www.nhs.uk/conditions/trigger-finger/treatment/

@開放性手術 (Open surgery)

開放性手術，是目前歐美較多採用，雖然成功率很高，但併發症達31%。

They reported 3% of major complications (synovial fistula, arthro-fibrosis) and 28% of minor complications (erythema, scar tissue stiffness, and loss of range of motion).

[Complications of open trigger finger release. J Hand Surg Am. 2010 Apr;35(4):594-6. ]

[Risk Factors for Postoperative Complications in Trigger Finger Release. Fed Pract. 2015 February;32(2):21-23]

@針頭閉合性鬆解術 (Percutaneous release by needle )

文獻中統計48個板機指接受經皮針頭鬆解術，成功率高，併症少，建議取代開放性手術治療。

Percutaneous surgical technique in the treatment of trigger finger is an effective, convenient and cost-effective method with a low complication rate, and is therefore a preferable alternative to open surgery.

[Percutaneous Surgery: A Safe Procedure for Trigger Finger? N Am J Med Sci. 2012 Sep; 4(9): 401–403.}

[US-guided Percutaneous Release of the Trigger Finger by Using a 21-gauge Needle: A Prospective Study of 60 Cases. Radiology: Volume 280: Number 2—August 2016]

[Open versus percutaneous release for trigger digits: Reversal between short-term and long-term outcomes. Journal of the Chinese Medical Association. June 2016, Pages 340-344]

@小針刀閉合性鬆解術 (Percutaneous release by small needle knife )

這是最新一篇的文獻統計發表於2019年，文中統計21個病人接受超音波導引針刀治療，20個病人只接受針刀治療。結果呈現成功率達100% vs 90% (超音波vs無超音波)。

[Ultrasound-Guided Percutaneous Release of A1 Pulley by Using a Needle Knife: A Prospective Study of 41 Cases. Front. Pharmacol., 26 March 2019 ]

# 結論:
1. 類固醇注射成功率低50-70%，復發率高 (>20%)。

2. 開放性手術在台灣和歐美還是主流。成功率高 (>90%)，但需注意副作用高達31%，尤其是傷口結疤難解，復發率高。

3. 經皮針頭鬆解術是目前西醫界操作主流，小針刀鬆解術是目前中醫界操作主流。

4. 閉合性鬆解術(針頭鬆解術或小針刀鬆解術)，若經超音波導引效果會更好，但要注意感染問題。其成功率和併發症，取決於醫師經驗。

5. 最新考科藍Cochrane研究結果: (沒有小針刀相關研究)

成功率: 類固醇注射成功率: 61%，開放性手術成功率: 92%。

疼痛率 (1週後): 類固醇疼痛率: 19%，開放性手術疼痛率: 33-66%。

復發率: 類固醇注射復發率:39%，開放性手術復發率: 3-60%。

閉合性手術研究，由於數量太少，證據力仍嫌不足，但成功率和開放性手術雷同。

［Surgery for trigger finger. Cochrane Systematic Review - Intervention Version published: 20 February 2018 see what's new］