Moehrlen U, Mazzone L, Bieli C, Weber D M
Department of Surgery, University Children's Hospital Zurich, Zurich, Switzerland.
Eur J Pediatr Surg. 2009 Apr;19(2):83-6. doi: 10.1055/s-2008-1039179. Epub 2009 Feb 11.
Aim of the study was to provide an age-adapted rehabilitation protocol for flexor tendon repairs of children and to evaluate a patient series accordingly.
A modified Kessler's technique was used to repair 49 flexor tendon injuries in 39 children. All children had immediate postoperative mobilization according to the protocol that provides specific guidelines for preschoolers, children and teenagers. Range of motion was monitored and the final results were evaluated retrospectively.
All children could be treated successfully according to the protocol with no occurrence of secondary tendon ruptures. Forty finger injuries were evaluated according to the Strickland classification, resulting in a median total active motion of 92.6 % with 29 (72.5 %) excellent results, 8 (20 %) good results, 3 (7.5 %) fair results and no poor result. All 7 thumbs had an excellent result according to the Buck-Gramcko score. There was no significant difference in outcomes between the three age groups.
The rehabilitation protocol provided in this study allows an age-adapted early mobilization of children's hands after flexor tendon injuries. It respects age-specific limitations in rehabilitation and takes a child's superior healing capacity compared to adults into account. The good results and the very low complication rate observed in the present series suggest that the extra effort of early mobilization may be justified.
本研究的目的是为儿童屈指肌腱修复提供适合年龄的康复方案，并据此评估一组患者。
采用改良的凯斯勒技术修复39例儿童的49处屈指肌腱损伤。所有儿童术后均按照该方案立即进行活动，该方案为学龄前儿童、儿童和青少年提供了具体指导方针。监测活动范围，并对最终结果进行回顾性评估。
所有儿童均能按照该方案成功治疗，未发生继发性肌腱断裂。根据斯特里克兰分类法对40例手指损伤进行评估，总主动活动度中位数为92.6%，其中29例（72.5%）结果为优，8例（20%）为良，3例（7.5%）为中，无差的结果。根据巴克-格拉姆科评分，所有7例拇指结果均为优。三个年龄组之间的结果无显著差异。
本研究提供的康复方案可使儿童屈指肌腱损伤后手部进行适合年龄的早期活动。它考虑到了康复中特定年龄的限制，并考虑到儿童与成人相比具有更强的愈合能力。本系列观察到的良好结果和极低的并发症发生率表明早期活动所付出的额外努力可能是合理的。
