| Name: | Description: | Size: | Format: | |
|---|---|---|---|---|
| 544.63 KB | Adobe PDF |
Authors
Advisor(s)
Abstract(s)
Introdução: O dedo em gatilho caracteriza-se por dor, rigidez e sensação de bloqueio na
movimentação do(s) dedo(s) afetado(s). A técnica percutânea da libertação do dedo em
gatilho destaca-se por ser menos invasiva e com uma recuperação mais rápida em
comparação com a cirurgia aberta, embora estejam relatadas possíveis riscos de lesão do
nervo digital e, por vezes, libertações incompletas da polia A1. A ecografia foi integrada
neste procedimento com o intuito de minimizar as complicações descritas, uma vez que
permite a visualização das estruturas anatómicas e ajuda a orientar os instrumentos
cirúrgicos utilizados. Esta revisão pretende concluir se a cirurgia percutânea ecoguiada é
uma abordagem com melhores outcomes quando comparada com a libertação percutânea
sem ecografia. O objetivo principal foi comparar a eficácia da técnica na resolução do
gatilho, evolução da dor e complicações, e os objetivos secundários avaliados foram o grau
de satisfação dos pacientes e o tempo de recuperação para as AVDs e/ou trabalho.
Métodos: Foi realizada, a sete e a 14 de junho de 2024, uma pesquisa e recolha da
literatura sobre a cirurgia de libertação percutânea do dedo em gatilho, seguindo o
diagrama das Guidelines PRISMA 2020. Foram utilizadas as bases de dados PubMed,
Scopus, Biblioteca Virtual en Salud (BVS) - coordenada pelo BIREME/OPAS/OMS, sendo
a LILACS a sua principal base de dados, recorrendo à seguinte equação de pesquisa:
(((trigger finger) OR (trigger digit) OR (trigger thumb)) AND ((percutaneous) OR
(minimally invasive))) NOT ((cadaver) OR (open)). Das três bases de dados, foram
recolhidos e importados para a aplicação Zotero todos os resultados da pesquisa. Com
base na estratégia PICO, foram incluídos os estudos que abordassem a técnica percutânea
da libertação da polia A1, exceto revisões sistemáticas e meta-análises. Foram excluídos
também estudos em cadáveres ou que abordassem resultados de infiltrações de
corticosteróides. As variáveis estudadas nesta revisão foram: libertação com sucesso de
dedos em gatilho, duração do período de recuperação e follow-up, grau de satisfação do
paciente, evolução da dor e complicações.
Resultados: No total foram recolhidos 285 artigos, dos quais foram selecionados 21 para
leitura integral. Após a leitura e análise dos dados de cada um, verifica-se que ambas as
técnicas possuem altas taxas resolução da patologia, entre os 72% e os 100%. Dos 21
artigos estudados, apenas quatro comparam diretamente a técnica percutânea com e sem
ecografia. Sendo estes estudos comparativos a técnica ecoguiada parece ter melhores
outcomes a curto-prazo, maior taxa de resolução do gatilho e menores complicações. Todos os artigos defendem que após uma intervenção percutânea, existe uma melhora
significativa no VAS score, independentemente do recurso à ecografia.
Conclusão: Os resultados desta revisão não permitem concluir que a libertação percutânea
da polia A1 com recurso a ecografia possui melhores outcomes do que a libertação
percutânea sem recurso à mesma, pelo que mais estudos serão necessários para mostrar a
superioridade de uma técnica em relação a outra.
Introduction: Trigger finger is characterized by pain, stiffness, and a locking sensation during the movement of the affected finger(s). The percutaneous technique for trigger finger release stands out for being less invasive and offering faster recovery compared to open surgery, although there are reported risks of digital nerve injury and, at times, incomplete releases of the A1 pulley. Ultrasound has been integrated into this procedure to minimize the described complications, as it allows visualization of anatomical structures and helps guide the surgical instruments used. This review aims to determine whether ultrasound-guided percutaneous surgery is a better approach compared to percutaneous release without ultrasound. The main objective was to compare the efficacy of the technique in resolving trigger finger, pain progression, and complications, while secondary objectives evaluated were patient satisfaction and recovery time for ADLs and/or work. Methods: A literature search on percutaneous trigger finger release surgery was conducted on June 7 and 14, 2024, following the PRISMA 2020 Guidelines diagram. The databases used were PubMed, Scopus, and Biblioteca Virtual en Salud (BVS) – coordinated by BIREME/PAHO/WHO, with LILACS being its main database – using the following search equation: (((trigger finger) OR (trigger digit) OR (trigger thumb)) AND ((percutaneous) OR (minimally invasive))) NOT ((cadaver) OR (open)). All search results from the three databases were collected and imported into the Zotero application. Based on the PICO strategy, studies addressing the percutaneous technique for A1 pulley release were included, except for systematic reviews and meta-analyses. Studies on cadavers or those addressing corticosteroid injection outcomes were also excluded. The variables studied in this review were: successful trigger finger release, duration of recovery period and followup, patient satisfaction level, pain progression, and complications. Results: A total of 285 articles were collected, of which 21 were selected for full-text review. After analyzing the data from each, it was found that both techniques have high resolution rates for the condition, ranging from 72% to 100%. Of the 21 articles reviewed, only four directly compared the percutaneous technique with and without ultrasound guidance. In these comparative studies, the ultrasound-guided technique appears to have better short-term outcomes, a higher trigger resolution rate, and fewer complications. All the articles agree that following a percutaneous intervention, there is a significant improvement in the VAS score, regardless of the use of ultrasound. Conclusion: The results of this review do not allow us to conclude that ultrasound-guided A1 pulley percutaneous release has better outcomes than percutaneous release without the use of ultrasound, indicating that further studies are needed to demonstrate the superiority of one technique over the other.
Introduction: Trigger finger is characterized by pain, stiffness, and a locking sensation during the movement of the affected finger(s). The percutaneous technique for trigger finger release stands out for being less invasive and offering faster recovery compared to open surgery, although there are reported risks of digital nerve injury and, at times, incomplete releases of the A1 pulley. Ultrasound has been integrated into this procedure to minimize the described complications, as it allows visualization of anatomical structures and helps guide the surgical instruments used. This review aims to determine whether ultrasound-guided percutaneous surgery is a better approach compared to percutaneous release without ultrasound. The main objective was to compare the efficacy of the technique in resolving trigger finger, pain progression, and complications, while secondary objectives evaluated were patient satisfaction and recovery time for ADLs and/or work. Methods: A literature search on percutaneous trigger finger release surgery was conducted on June 7 and 14, 2024, following the PRISMA 2020 Guidelines diagram. The databases used were PubMed, Scopus, and Biblioteca Virtual en Salud (BVS) – coordinated by BIREME/PAHO/WHO, with LILACS being its main database – using the following search equation: (((trigger finger) OR (trigger digit) OR (trigger thumb)) AND ((percutaneous) OR (minimally invasive))) NOT ((cadaver) OR (open)). All search results from the three databases were collected and imported into the Zotero application. Based on the PICO strategy, studies addressing the percutaneous technique for A1 pulley release were included, except for systematic reviews and meta-analyses. Studies on cadavers or those addressing corticosteroid injection outcomes were also excluded. The variables studied in this review were: successful trigger finger release, duration of recovery period and followup, patient satisfaction level, pain progression, and complications. Results: A total of 285 articles were collected, of which 21 were selected for full-text review. After analyzing the data from each, it was found that both techniques have high resolution rates for the condition, ranging from 72% to 100%. Of the 21 articles reviewed, only four directly compared the percutaneous technique with and without ultrasound guidance. In these comparative studies, the ultrasound-guided technique appears to have better short-term outcomes, a higher trigger resolution rate, and fewer complications. All the articles agree that following a percutaneous intervention, there is a significant improvement in the VAS score, regardless of the use of ultrasound. Conclusion: The results of this review do not allow us to conclude that ultrasound-guided A1 pulley percutaneous release has better outcomes than percutaneous release without the use of ultrasound, indicating that further studies are needed to demonstrate the superiority of one technique over the other.
Description
Keywords
Bloqueio do Tendão Dedo em Gatilho Ecografia Intervencionista Procedimentos Cirúrgicos Minimamente Invasivos