PDF(Pubmed)
Abstract：
BACKGROUND: Trigger thumb is a prevalent hand condition observed in children, and its management remains a topic of considerable debate, ranging from mere observation to surgical intervention. In recent times, there has been a growing interest in exploring nonoperative treatments as alternatives to surgical procedures for managing pediatric trigger thumb. Gaining insight into the prevalence of spontaneous resolution in pediatric trigger thumb is of paramount importance. However, the literature presents a wide variation in estimates regarding the prevalence of this spontaneous resolution, highlighting the need for further investigation and consensus. The aim of this review was to estimate the overall prevalence of spontaneous resolution among pediatric trigger thumb.
METHODS: This study meticulously followed the PRISMA guidelines and registered in the PROSPERO. The PubMed, Embase, and Cochrane Library databases were searched for all relevant studies up to May 2024.Inclusion criteria were studies reported only observation spontaneous resolution pediatric trigger thumb, aged up to 14 years, reported at least 10 thumbs and followed up time at least 3 months. Confounded intervention treatment measure studies were excluded. To synthesize the prevalence rates from individual studies, we employed a random-effects meta-analysis. In order to uncover the sources of heterogeneity and to compare prevalence estimates across different groups, we performed sensitivity and subgroup analyses. To meticulously evaluate the quality of the included studies, the Joanna Briggs Institute\'s quality assessment checklist was employed. Furthermore, to assess the heterogeneity among the studies, both Cochran\'s Q test and the I² statistic were utilized.
RESULTS: A total of eleven studies were included for the final analysis, with 599 pediatric trigger thumbs. Our final meta-analysis showed that more than one-third of these pediatric trigger thumb cases resolved spontaneously, with a resolution rate of 43.5% (95% CI 29.6-58.6). Subgroup analyses showed that in terms of age at the first visit, the prevalence of spontaneous resolution in the less than 24 months group and in the 24 months or older group was 38.7%(95% CI 18.1-64.4)and 45.8%(95% CI 27.4-65.4), respectively. There was no significant difference between the two groups(P = 0.690). When analyzing follow up time, the prevalence of spontaneous resolution in the 24 months or longer group and in the less than 24 months group was 58.9%(95% CI 41.6-74.2)and 26.8%(95% CI 14.7-43.8), respectively.There was significant statistical differences between the two groups(P = 0.009). Based on the initial severity of interphalangeal (IP) joint flexion contracture, the prevalence of spontaneous resolution in the 30 degrees or less group and in the other measurements group was 54.1%(95% CI 31.5-75.1)and 37.1%(95% CI 21.9-55.4), respectively.There was no significant difference between the two groups(P = 0.259).
CONCLUSIONS: Our study demonstrates that a significant proportion of pediatric trigger thumbs resolve spontaneously. This finding highlights the benefits of early observation in managing this condition. By prioritizing non-operative observation, both parents and surgeons are better equipped to make informed decisions regarding the treatment of pediatric trigger thumb, potentially reducing the need for surgical intervention.
METHODS: This study meticulously followed the PRISMA guidelines and registered in the PROSPERO. The PubMed, Embase, and Cochrane Library databases were searched for all relevant studies up to May 2024.Inclusion criteria were studies reported only observation spontaneous resolution pediatric trigger thumb, aged up to 14 years, reported at least 10 thumbs and followed up time at least 3 months. Confounded intervention treatment measure studies were excluded. To synthesize the prevalence rates from individual studies, we employed a random-effects meta-analysis. In order to uncover the sources of heterogeneity and to compare prevalence estimates across different groups, we performed sensitivity and subgroup analyses. To meticulously evaluate the quality of the included studies, the Joanna Briggs Institute\'s quality assessment checklist was employed. Furthermore, to assess the heterogeneity among the studies, both Cochran\'s Q test and the I² statistic were utilized.
RESULTS: A total of eleven studies were included for the final analysis, with 599 pediatric trigger thumbs. Our final meta-analysis showed that more than one-third of these pediatric trigger thumb cases resolved spontaneously, with a resolution rate of 43.5% (95% CI 29.6-58.6). Subgroup analyses showed that in terms of age at the first visit, the prevalence of spontaneous resolution in the less than 24 months group and in the 24 months or older group was 38.7%(95% CI 18.1-64.4)and 45.8%(95% CI 27.4-65.4), respectively. There was no significant difference between the two groups(P = 0.690). When analyzing follow up time, the prevalence of spontaneous resolution in the 24 months or longer group and in the less than 24 months group was 58.9%(95% CI 41.6-74.2)and 26.8%(95% CI 14.7-43.8), respectively.There was significant statistical differences between the two groups(P = 0.009). Based on the initial severity of interphalangeal (IP) joint flexion contracture, the prevalence of spontaneous resolution in the 30 degrees or less group and in the other measurements group was 54.1%(95% CI 31.5-75.1)and 37.1%(95% CI 21.9-55.4), respectively.There was no significant difference between the two groups(P = 0.259).
CONCLUSIONS: Our study demonstrates that a significant proportion of pediatric trigger thumbs resolve spontaneously. This finding highlights the benefits of early observation in managing this condition. By prioritizing non-operative observation, both parents and surgeons are better equipped to make informed decisions regarding the treatment of pediatric trigger thumb, potentially reducing the need for surgical intervention.
摘要：
背景：触发拇指是儿童常见的手部疾病，它的管理仍然是一个相当辩论的话题，从单纯的观察到手术干预。最近,越来越多的人对探索非手术治疗作为治疗小儿扳机拇指的外科手术的替代方法感兴趣.深入了解小儿触发拇指自发消退的患病率至关重要。然而,文献提出了关于这种自发决议的普遍性的估计有很大差异，强调需要进一步调查和达成共识。这篇综述的目的是估计小儿触发拇指自发消退的总体患病率。
方法：本研究遵循PRISMA指南并在PROSPERO中注册。PubMed,Embase,和CochraneLibrary数据库搜索了截至2024年5月的所有相关研究。纳入标准是研究报告仅观察自发解决小儿触发拇指，14岁以下,报告了至少10个拇指，随访时间至少3个月。排除了混淆的干预治疗措施研究。综合个别研究的患病率，我们采用了随机效应荟萃分析。为了揭示异质性的来源，并比较不同群体的患病率估计，我们进行了敏感性和亚组分析.仔细评估纳入研究的质量，乔安娜·布里格斯研究所的质量评估清单被采用。此外，为了评估研究之间的异质性，同时使用了Cochran的Q检验和I²统计量。
结果：共有11项研究纳入最终分析，有599个儿科触发器拇指。我们最终的荟萃分析显示，超过三分之一的这些儿科触发拇指病例自发解决，分辨率为43.5%（95%CI29.6-58.6）。亚组分析显示，就第一次就诊时的年龄而言，少于24个月组和24个月及以上组的自发消退率分别为38.7%(95%CI18.1-64.4)和45.8%(95%CI27.4-65.4),分别。两组间差异无统计学意义(P=0.690)。在分析随访时间时，24个月或更长时间组及少于24个月组的自发消退率分别为58.9%(95%CI41.6-74.2)和26.8%(95%CI14.7-43.8),分别。两组间差异有统计学意义(P=0.009)。根据指间（IP）关节屈曲挛缩的初始严重程度，30度或以下组和其他测量组中自发消退的患病率分别为54.1%(95%CI31.5-75.1)和37.1%(95%CI21.9-55.4),分别。两组间差异无统计学意义(P=0.259)。
结论：我们的研究表明，相当比例的小儿触发拇指自发消退。这一发现强调了早期观察在控制这种情况方面的好处。通过优先考虑非手术观察，父母和外科医生都更有能力就小儿扳机拇指的治疗做出明智的决定，有可能减少手术干预的需要。
方法：本研究遵循PRISMA指南并在PROSPERO中注册。PubMed,Embase,和CochraneLibrary数据库搜索了截至2024年5月的所有相关研究。纳入标准是研究报告仅观察自发解决小儿触发拇指，14岁以下,报告了至少10个拇指，随访时间至少3个月。排除了混淆的干预治疗措施研究。综合个别研究的患病率，我们采用了随机效应荟萃分析。为了揭示异质性的来源，并比较不同群体的患病率估计，我们进行了敏感性和亚组分析.仔细评估纳入研究的质量，乔安娜·布里格斯研究所的质量评估清单被采用。此外，为了评估研究之间的异质性，同时使用了Cochran的Q检验和I²统计量。
结果：共有11项研究纳入最终分析，有599个儿科触发器拇指。我们最终的荟萃分析显示，超过三分之一的这些儿科触发拇指病例自发解决，分辨率为43.5%（95%CI29.6-58.6）。亚组分析显示，就第一次就诊时的年龄而言，少于24个月组和24个月及以上组的自发消退率分别为38.7%(95%CI18.1-64.4)和45.8%(95%CI27.4-65.4),分别。两组间差异无统计学意义(P=0.690)。在分析随访时间时，24个月或更长时间组及少于24个月组的自发消退率分别为58.9%(95%CI41.6-74.2)和26.8%(95%CI14.7-43.8),分别。两组间差异有统计学意义(P=0.009)。根据指间（IP）关节屈曲挛缩的初始严重程度，30度或以下组和其他测量组中自发消退的患病率分别为54.1%(95%CI31.5-75.1)和37.1%(95%CI21.9-55.4),分别。两组间差异无统计学意义(P=0.259)。
结论：我们的研究表明，相当比例的小儿触发拇指自发消退。这一发现强调了早期观察在控制这种情况方面的好处。通过优先考虑非手术观察，父母和外科医生都更有能力就小儿扳机拇指的治疗做出明智的决定，有可能减少手术干预的需要。
