Safety and efficacy of ultrasound-guided percutaneous A1 pulley release using a needle knife: An anatomical study

Zuyun Qiu; Hui Li; Yifeng Shen; Yan Jia; Xiaojie Sun; Qiaoyin Zhou; Shiliang Li; Weiguang Zhang

doi:10.3389/fsurg.2022.967400

Safety and efficacy of ultrasound-guided percutaneous A1 pulley release using a needle knife: An anatomical study

Front Surg. 2022 Sep 20:9:967400. doi: 10.3389/fsurg.2022.967400. eCollection 2022.

Authors

Zuyun Qiu¹, Hui Li², Yifeng Shen³, Yan Jia², Xiaojie Sun², Qiaoyin Zhou⁴, Shiliang Li², Weiguang Zhang⁵

Affiliations

¹ Department of Traditional Chinese Medicine Bone-Setting, Beijing Jishuitan Hospital, Beijing, China.
² Department of Acupuncture and Moxibustion, China-Japan Friendship Hospital, Beijing, China.
³ Department of Traditional Chinese Surgery, Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, China.
⁴ Chinese Medicine College, Fujian University of Traditional Chinese Medicine, Fuzhou, China.
⁵ Department of Human Anatomy, School of Basic Medical Sciences, Peking University, Beijing, China.

Abstract

Objective: The present study aimed to assess the efﬁcacy and safety of ultrasound-guided percutaneous A1 pulley release using a needle knife.

Methods: The author performed percutaneous A1 pulley release in 84 cadaveric hands fixed with 10% formalin. The cadaveric hands were divided into three groups: 28 hands in each group (group U: ultrasound-guided needle knife pushing group, group N: non-ultrasound-guided needle knife pushing group, group T: classical needle knife operation puncture group). Percutaneous A1 pulley release was performed, the soft tissue was dissected layer by layer, and the relevant anatomical data were measured.

Results: The injured cases were as follows: group U, 29 (20.7%); group N, 36 (25.7%); and group T, 28 (20.0%). There is no significant difference between different tissue injury types in different intervention methods. The missed release cases were as follows: group U, 8 (5.7%); group N, 4 (2.9%); and group T, 13 (9.3%). The percentage of released A1 pulley were as follows: group U, 71.4% ± 30.7%; group N, 66.0% ± 20.3%; and group T, 61.0% ± 30.4%. The percentage of released A1 pulley of the three groups were compared: group U > group N > group T, and there was statistical difference between the three groups. The full release rates of the three groups were compared: group U(31.4%) > group N(15.7%) > group T(13.6%), and there were significant difference in the full release of A1 pulley between group U and group T, group N.

Conclusion: Based on the cadaver specimen, the length and percentage of released A1 pulley is longer by ultrasound-guided percutaneous A1 pulley release using a needle-knife. and there was no statistical difference in the injury rate between the three techniques.

Type of study and clinical relevance: Clinical anatomic study. To test the efﬁcacy and safety of ultrasound-guided percutaneous A1 pulley release using a needle knife in cadaveric hands, and provide an anatomically based support in clinic.

Keywords: a1 pulley; anatomy; needle-knife; percutaneous release; stenosing flexor tenosynovitis; trigger finger; ultrasound-guided technique.