LEPRA Funded Leprosy Reconstructive Surgery Unit HOINA, Muniguda, Orissa, India.
J Plast Reconstr Aesthet Surg. 2010 Mar;63(3):554-60. doi: 10.1016/j.bjps.2008.11.095. Epub 2009 Feb 20.
After tibialis posterior tendon transfer surgery for foot-drop correction, the foot is traditionally immobilised for several weeks. To test the feasibility of early mobilisation after this procedure in patients with Hansen's disease, 21 consecutive patients received active mobilisation of the transfer starting on the 5th postoperative day. Transfer insertion strength was enhanced by Pulvertaft weave. The results were compared with a historical cohort of 21 patients receiving 4 weeks of immobilisation. The primary outcomes were active dorsiflexion, active plantar flexion and total active motion at the ankle, tendon-insertion pullout and time until discharge from rehabilitation with independent walking without aid. Assessments at discharge from rehabilitation and the last clinical follow-up at more than 1 year were compared between both groups. The Student's t-test was used to compare data between the groups, and 95% confidence interval of the difference between groups was determined. A p-value of 0.05 was considered statistically significant. The average follow-up was 22 months for both groups. There was no incidence of insertion pullout of the tendon transfer in either group. In addition, there was no difference in active dorsiflexion angle between the groups at discharge (mean difference: 2.2 degrees, p=0.22) and final assessment (mean difference: 2.3 degrees, p=0.42). The plantar flexion angles were similar in both groups at discharge (mean difference: 0.5 degrees, p=0.86) and final assessment (mean difference: 0.5 degrees, p=0.57). In addition, there was no difference in total active motion between the groups at discharge (mean difference: 2 degrees, p=0.54) and final assessment (mean difference: 1 degrees, p=0.49). The patients were discharged from rehabilitation with independent walking at 44.04+/-7.9 days after surgery in the mobilisation group compared to 57.07+/-2.3 days in the immobilisation group. This indicates a significant difference in morbidity (mean difference: 13 days, p<0.001) between the two groups. In summary, this feasibility study indicates that early active mobilisation of tibialis posterior transfer in patients with Hansen's disease is safe and has similar outcomes to immobilisation with a reduced time to independent walking, warranting the design of a controlled clinical trial to further substantiate this.
在进行跟腱后肌转移手术以纠正足下垂后，传统上会将脚部固定数周。为了测试在麻风病患者中进行此手术后早期活动的可行性，连续 21 名患者在术后第 5 天开始接受转移的主动活动。通过 Pulvertaft 编织增强了转移插入的强度。结果与接受 4 周固定的 21 名历史队列患者进行了比较。主要结局是踝关节的主动背屈、主动跖屈和总主动运动、肌腱插入拔出以及无需辅助即可独立行走并从康复中出院的时间。比较两组患者的康复出院时和 1 年以上的最后临床随访时的评估。使用学生 t 检验比较两组之间的数据，并确定组间差异的 95%置信区间。p 值<0.05 被认为具有统计学意义。两组的平均随访时间均为 22 个月。两组均未发生肌腱转移插入拔出。此外，两组在出院时（平均差异：2.2 度，p=0.22）和最终评估时（平均差异：2.3 度，p=0.42）的主动背屈角度无差异。两组出院时（平均差异：0.5 度，p=0.86）和最终评估时（平均差异：0.5 度，p=0.57）的跖屈角度相似。此外，两组出院时（平均差异：2 度，p=0.54）和最终评估时（平均差异：1 度，p=0.49）的总主动运动无差异。在移动组中，患者在手术后 44.04+/-7.9 天即可独立行走从康复中出院，而在固定组中则为 57.07+/-2.3 天。这表明两组之间的发病率存在显著差异（平均差异：13 天，p<0.001）。总之，这项可行性研究表明，在麻风病患者中进行跟腱后肌转移的早期主动活动是安全的，与固定相比，其独立行走的时间更短，需要设计一项对照临床试验来进一步证实这一点。
