Stewart K M
New York Group for Plastic Surgery and Rehabilitation, Monroe.
Hand Clin. 1991 Aug;7(3):447-60.
The precision of the Evans/Burkhalter protocol and the work by Silverman and associates exemplify one of the most valuable of all current trends in rehabilitation of the healing tendon. Knowledge of tendon excursion at each level and throughout the range of motion in each joint gives us safe parameters for tendon mobilization. Hand rehabilitation is becoming more of a science while remaining an art. Research into tendon healing, nutrition, anatomy, biomechanics, and physiology gives us a solid basis for our treatment techniques. We now need to replicate studies already performed and quantify more precisely the data we have. Many questions remain unanswered. There is a wide variety in the position of splinting for flexor tendon mobilization under current protocols: What joint positions are optimal and why? The number and frequency of repetitions in early mobilization protocols varies greatly: What number and frequency is more appropriate for which patients? How much tendon excursion will control adhesions, promote healing, and avoid gap formation or elongation of the repair? How much force should we apply passively to maintain or increase joint motion? How soon should we start active motion, and how can we control the strength of those early muscle contractions? Do "place-hold" exercises truly place less tension on the repair site? How soon should we begin resisted exercise, and how much resistance are we applying with each type of exercise? Should blocking exercises be considered resistive? How should tendon management protocols be adapted in the presence of associated injuries? Lack of space has prevented discussion here of recent and needed research in a number of areas, such as the effectiveness and appropriate precautions for the use of ultrasound, iontophoresis, and neuromuscular electrical stimulation in tendon management. The evidence is growing, but we have a long way to go. To improve our clinical results, the trend toward precision must continue and grow.
埃文斯/布尔哈尔特方案的精确性以及西尔弗曼及其同事的研究成果，体现了当前愈合肌腱康复领域所有最有价值的趋势之一。了解每个层面的肌腱移动情况以及每个关节在整个活动范围内的情况，为我们进行肌腱松动术提供了安全参数。手部康复正日益成为一门科学，同时仍然是一门艺术。对肌腱愈合、营养、解剖学、生物力学和生理学的研究，为我们的治疗技术提供了坚实的基础。我们现在需要重复已进行的研究，并更精确地量化我们所拥有的数据。许多问题仍未得到解答。在当前方案下，屈肌腱松动术的夹板固定位置存在很大差异：哪些关节位置是最佳的，原因是什么？早期松动术方案中的重复次数和频率差异很大：对于哪些患者，多少次重复和何种频率更为合适？多少肌腱移动量能够控制粘连、促进愈合并避免修复部位出现间隙形成或延长？我们应被动施加多大的力来维持或增加关节活动度？我们应多早开始主动活动，以及如何控制那些早期肌肉收缩的强度？“占位”练习是否真的对修复部位施加了更小的张力？我们应多早开始抗阻训练，以及每种类型的训练施加了多大的阻力？闭链练习应被视为抗阻练习吗？在存在相关损伤的情况下，肌腱处理方案应如何调整？篇幅所限，此处无法讨论多个领域近期所需的研究，例如在肌腱处理中使用超声、离子导入和神经肌肉电刺激的有效性及适当预防措施。证据越来越多，但我们仍有很长的路要走。为了改善我们的临床效果，精确化的趋势必须持续并加强。
