Rath Santosh, Selles Ruud W, Schreuders Ton A R, Stam Henk J, Hovius Steven E R
LEPRA Funded Leprosy Reconstructive Surgery Unit, HOINA, Muniguda, Orissa, India.
J Hand Surg Am. 2009 Mar;34(3):488-94, 494.e1-5. doi: 10.1016/j.jhsa.2008.11.014.
Immobilization after tendon transfers has been the conventional postoperative management. A recent study indicated beneficial effects of an immediate active motion protocol (IAMP) after tendon transfer for claw deformity correction compared with effects in a historical cohort. In this study, we further tested this hypothesis in a randomized clinical trial comparing the effectiveness of the IAMP with that of conventional immobilization.
Fifty supple claw hand deformities were randomized postoperatively into 2 equal groups for IAMP and immobilization. Therapy began on the second postoperative day for the IAMP group and on the twenty-second postoperative day for the immobilization group. The primary outcome measures were deformity correction, active range of motion of digits, tendon transfer insertion pullout, and time until discharge from rehabilitation. Secondary outcome measures were swelling, pain, hand strength, and dexterity. Both groups were compared at discharge from rehabilitation and at the last clinical follow-up (at least 1 year postoperatively).
Assessments were available for all 50 patients at discharge and for 23 patients in each group at follow-up. The average follow-up was 18 months for the IAMP group and 17 months for the immobilization group. Deformity correction, range of motion, swelling, dexterity, and hand strength were similar for both groups at discharge and a follow-up. There was no evidence of tendon insertion pullout in any patient of either group. Relief of pain was achieved significantly earlier with IAMP. Morbidity was reduced by, on average, 22 days with IAMP.
We found that the immediate active motion protocol is safe and has similar outcomes compared with those of immobilization, with the added advantage of earlier pain relief and quicker restoration of hand function. Immediate motion after tendon transfer can significantly reduce morbidity and speed up the rehabilitation of paralytic limbs, and it may save expense for the patients.
肌腱转位术后制动一直是传统的术后管理方法。最近一项研究表明，与历史队列相比，肌腱转位后采用即时主动活动方案（IAMP）矫正爪形畸形有有益效果。在本研究中，我们在一项随机临床试验中进一步验证了这一假设，比较了IAMP与传统制动的有效性。
50例柔软型爪形手畸形患者术后随机分为两组，分别接受IAMP和制动治疗。IAMP组术后第二天开始治疗，制动组术后第二十二天开始治疗。主要观察指标为畸形矫正、手指主动活动范围、肌腱转位植入处拔出情况以及康复出院时间。次要观察指标为肿胀、疼痛、手部力量和灵活性。两组在康复出院时和最后一次临床随访（术后至少1年）时进行比较。
所有50例患者出院时均有评估数据，随访时每组有23例患者有评估数据。IAMP组平均随访18个月，制动组平均随访17个月。两组在出院时和随访时的畸形矫正、活动范围、肿胀、灵活性和手部力量相似。两组患者均未出现肌腱植入处拔出的情况。IAMP组疼痛缓解明显更早。IAMP组平均发病率降低22天。
我们发现，即时主动活动方案是安全的，与制动相比效果相似，还具有疼痛缓解更早、手部功能恢复更快的额外优势。肌腱转位后即时活动可显著降低发病率，加快瘫痪肢体的康复，还可能为患者节省费用。
