Ahmad Muhammad, Hussain Syed Shahid, Tariq Farhan, Rafiq Zulqarnain, Khan M Ibrahim, Malik Saleem A
Department of Plastic Surgery, Pakistan Institute of Medical Sciences (PIMS), Islamabad.
J Ayub Med Coll Abbottabad. 2007 Jan-Mar;19(1):6-9.
Flexor tendon injury is one of the most common hand injuries. This initial treatment is of the utmost importance because it often determines the final outcome; inadequate primary treatment is likely to give poor long tem results. Various suture techniques have been devised for tendon repair but the modified Kessler's technique is the most commonly used. This study was conducted in order to know the cause, mechanism and the effects of early controlled mobilization after flexor tendon repair and to assess the range of active motion after flexor tendon repair in hand.
This study was conducted at the department of Plastic Surgery, Pakistan Institute of Medical Sciences, Islamabad from 1st March 2002 to 31st August 2003. Only adult patients of either sex with an acute injury were included in whom primary or delayed primary tendon repair was undertaken. In all the patients, modified Kessler's technique was used for the repair using non-absorbable monofilament (Prolene 4-0). The wound was closed with interrupted non-absorbable, polyfilament (Silk 4-0) suture. A dorsal splint extending beyond the finger tip to proximal forearm was used with wrist in 20-30 degrees palmer flexion, metacarpophalangeal (MP) joint flexed at 60 degrees. Passive movements of fingers were started from the first post operative day, and for controlled, active movements, a dynamic splint was applied.
During this study, 33 patients with 39 digits were studies. 94% of the patients had right dominated hand involvement. 51% had the complete flexor digitorum superficialis (FDS) and flexor digitorum profundus (FDP) injuries. Middle and ring fingers were most commonly involved. Thumb was involved in 9% of the patients. Zone III(46%) was the commonest to be involved followed by zone II (28%). Laceration with sharp object was the most frequent cause of injury. Finger tip to distal palmer crease distance (TPD) was < 2.0 cm in 71% cases (average 2.4cm) at the end of 2nd postoperative week. Total number of patients was 34 at the end of 6th week. TPD was < 2.0 cm in 55% patients and < 1.0 cm in 38% cases (average 1.5cm) at the end of 6th week. Total 9 patients were lost to the follow up at the end of 8th week. TPD was < 1.0 cm in 67% (average 0.9 cm) at the end of 8th postoperative week. No case of disruption of repair was noted during the study.
Early active mobilization programme is essential after tendon repair. Majority of the patients (92%) had fair to good results at the end of 2nd week which increased to 97% at the end of 8th week to good to excellent.
屈指肌腱损伤是最常见的手部损伤之一。初始治疗极为重要，因为它常常决定最终结果；初期治疗不当很可能导致远期效果不佳。已设计出各种肌腱缝合技术用于肌腱修复，但改良凯斯勒技术是最常用的。进行这项研究是为了了解屈指肌腱修复后早期控制性活动的原因、机制及效果，并评估手部屈指肌腱修复后的主动活动范围。
本研究于2002年3月1日至2003年8月31日在伊斯兰堡巴基斯坦医学科学研究所整形科进行。仅纳入急性损伤的成年患者，对其进行一期或延迟一期肌腱修复。所有患者均采用改良凯斯勒技术，使用不可吸收单丝缝线（普理灵4-0）进行修复。伤口用间断不可吸收多丝缝线（丝线4-0）缝合。使用一个背侧夹板，其延伸至指尖以外并达前臂近端，手腕处于掌屈20 - 30度，掌指关节屈曲60度。术后第一天开始进行手指被动活动，对于控制性主动活动，则应用动力夹板。
本研究期间，对33例患者的39根手指进行了研究。94%的患者右手受累为主。51%的患者指浅屈肌（FDS）和指深屈肌（FDP）完全损伤。中指和环指最常受累。9%的患者拇指受累。Ⅲ区（46%）是最常受累的区域，其次是Ⅱ区（28%）。锐器切割伤是最常见的损伤原因。术后第2周结束时，71%的病例指尖至掌远侧横纹距离（TPD）<2.0 cm（平均2.4 cm）。第6周结束时患者总数为34例。第6周结束时，55%的患者TPD<2.0 cm，38%的病例<1.0 cm（平均1.5 cm）。第8周结束时共有9例患者失访。术后第8周结束时，67%的患者TPD<1.0 cm（平均0.9 cm）。研究期间未发现修复处断裂的病例。
肌腱修复后早期主动活动方案至关重要。大多数患者（92%）在术后第2周结束时效果为尚可至良好，至第8周结束时这一比例增至97%，效果为良好至优秀。
