Rath Santosh
LEPRA-HOINA Leprosy Reconstructive Surgery Unit, Muniguda, Orissa, India.
J Hand Surg Am. 2008 Feb;33(2):232-40. doi: 10.1016/j.jhsa.2007.10.012.
To test the hypothesis that immediate postoperative active mobilization of tendon transfer following claw correction with flexor digitorum superficialis 4-tail pulley insertion will achieve similar outcomes to immobilization in a cast for 3 weeks.
In a prospective study, 32 hands with complete ulnar nerve paralysis had flexor digitorum superficialis middle finger 4-tail pulley insertions for 4-digit claw deformity correction and mobilization for tendon transfer rehabilitation on the second day after surgery. Surgical technique was modified to increase the strength of transfer slip insertion. Historical records of 32 mobile claw deformities treated prior to the prospective trial in the same institution with a similar procedure and immobilized in a cast for 3 weeks was used for comparison. Outcomes were assessed by (1) the status of tendon transfer attachment to flexor pulley during immediate mobilization to detect tendon transfer insertion pullout; (2) results of the claw correction in open hand position and intrinsic plus position, and range of digit flexion using identical outcome measures (3) morbidity following surgery; and (4) comparing results of immediate mobilization with immobilization.
There was no incidence of transfer insertion pullout during immediate postoperative mobilization. There was no clinically relevant difference in results of claw correction of both groups in open hand and intrinsic plus position. Total active motion of digit flexion was considerably better with immediate mobilization at late result. A reduction of morbidity by 21 days and an earlier return to daily living activities were benefits to the patient with immediate postoperative mobilization of tendon transfer for claw correction.
This study supports the hypothesis. Immediate postoperative active mobilization is safe and has similar outcomes of deformity correction compared to immobilization. Immediate mobilization has the added benefits of reduced morbidity and improved total active range of digit flexion compared to immobilization.
TYPE OF STUDY/LEVEL OF EVIDENCE: Therapeutic II.
检验以下假设，即采用指浅屈肌四尾滑车植入法矫正爪形畸形后立即进行术后主动活动肌腱转位，其效果与石膏固定3周相似。
在一项前瞻性研究中，32例尺神经完全麻痹患者的手在手术第二天采用指浅屈肌中指四尾滑车植入法矫正四指爪形畸形，并进行肌腱转位康复活动。对手术技术进行了改良，以增强转位肌腱的附着强度。将该前瞻性试验之前在同一机构采用类似手术方法并石膏固定3周治疗的32例可动性爪形畸形的历史记录用作对照。通过以下方面评估结果：（1）立即活动期间肌腱转位附着于屈肌滑车的情况，以检测肌腱转位植入物的拔出；（2）在伸指位和内在肌加力位的爪形畸形矫正结果，以及使用相同的结果测量指标评估手指屈曲范围；（3）术后发病率；（4）比较立即活动与固定的结果。
术后立即活动期间未发生转位植入物拔出。两组在伸指位和内在肌加力位的爪形畸形矫正结果在临床上无显著差异。在晚期结果中，立即活动时手指屈曲的总主动活动度明显更好。术后立即进行肌腱转位矫正爪形畸形，可使发病率降低21天，并使患者更早恢复日常生活活动。
本研究支持该假设。术后立即进行主动活动是安全的，与固定相比，畸形矫正效果相似。与固定相比，立即活动还有降低发病率和改善手指屈曲总主动活动范围的额外益处。
研究类型/证据水平：治疗性II级。
