Carl H D, Forst R, Schaller P
Orthopaedische Klinik mit Poliklinik, Friedrich-Alexander-University Erlangen-Nurenberg, Rathsberger Str. 57, 91054 Erlangen, Germany.
Arch Orthop Trauma Surg. 2007 Feb;127(2):115-9. doi: 10.1007/s00402-006-0233-3. Epub 2006 Sep 30.
The outcome of primary extensor repair in hand surgery has been widely explored, but little systematic effort has been made to investigate the influence of the anatomical zone of tendon injury. Therefore, the aim of our study was to assess the outcome of primary extensor tendon repair with a special focus on the pre-operative state and Verdan's anatomical zones. Our hypothesis being tested was that the outcome after primary extensor repair depends on the complexity of trauma and the site of lesion.
One hundred and seventy seven patients with 203 extensor tendon repairs were studied. After tendon repair and a 6-week protective immobilization, physiotherapy was carried out. A score proposed by Geldmacher and Schwarzbach was applied to estimate the outcome pre-operatively and to assess the results in a follow-up after a mean of 13 months. Correlations were tested between the anatomical zone of tendon injury, the pre-operative expectation and the results as considered both by the patient and the physician.
In Verdan's zones 1, 2, 4 and 5, excellent or good results were obtained in the vast majority of patients. Due to a higher frequency of complex injuries with concomitant soft tissue and bony injuries, the outcome was significantly worse after tendon repair in zones 3 and 6, as expected after the pre-operative estimation. In addition, a strong correlation was found for all anatomical zones between the pre-operative estimation and the outcome as judged both by the physician and the patient.
Recovery of finger function after primary extensor tendon repair depends on the complexity of trauma and the anatomical zone of tendon injury. Static splinting is an appropriate tool after primary extensor tendon repair in Verdan's zone 1, 2, 4 and 5, whereas injuries in zones 3 and 6 may demand for a different treatment regimen.
手部手术中一期伸肌腱修复的结果已得到广泛研究，但在研究肌腱损伤的解剖区域影响方面，系统性的工作做得很少。因此，我们研究的目的是评估一期伸肌腱修复的结果，特别关注术前状态和韦尔丹（Verdan）解剖区域。我们要验证的假设是，一期伸肌腱修复后的结果取决于创伤的复杂性和损伤部位。
对177例患者的203处伸肌腱修复进行了研究。肌腱修复并进行6周的保护性固定后，开展物理治疗。采用盖尔德马赫（Geldmacher）和施瓦茨巴赫（Schwarzbach）提出的评分系统在术前评估结果，并在平均13个月的随访中评估结果。对肌腱损伤的解剖区域、术前预期以及患者和医生所认为的结果之间的相关性进行了检验。
在韦尔丹区域1、2、4和5，绝大多数患者获得了优良结果。由于伴有软组织和骨损伤的复杂损伤频率较高，如术前估计的那样，区域3和6的肌腱修复后结果明显更差。此外，在所有解剖区域，医生和患者判断的术前估计与结果之间均发现有很强的相关性。
一期伸肌腱修复后手指功能的恢复取决于创伤的复杂性和肌腱损伤的解剖区域。对于韦尔丹区域1、2、4和5的一期伸肌腱修复，静态夹板固定是一种合适的方法，而区域3和6的损伤可能需要不同的治疗方案。
