LEPRA Funded Leprosy Reconstructive Surgery Unit, HOINA, Muniguda, Orissa, India.
Clin Orthop Relat Res. 2010 Sep;468(9):2477-84. doi: 10.1007/s11999-010-1342-4. Epub 2010 Apr 17.
Immobilization after tendon transfers has been the conventional postoperative management. Several recent studies suggest early mobilization does not increase tendon pullout.
QUESTIONS/PURPOSES: To confirm those studies we determined whether when compared with immobilization early active mobilization after a tendon transfer for foot-drop correction would (1) have a similar low rate of tendon insertion pullout, (2) reduce rehabilitation time, and (3) result in similar functional outcomes (active ankle dorsiflexion, plantar flexion, ROM, walking ability, Stanmore score, and resolution of functional problems.
We randomized 24 patients with surgically corrected foot-drop deformities to postoperative treatment with early mobilization with active motion at 5 days (n = 13) or 4 weeks of immobilization with active motion at 29 days (n = 11). In both groups, the tibialis posterior tendon was transferred to the extensor hallucis longus and extensors digitorum communis for foot-drop correction. Rehabilitation time was defined as the time from surgery until discharge from rehabilitation with independent walking. The minimum followup was 16 months (mean, 19 months; range, 16-38 months) in both groups.
We observed no case of tendon pullout in either group. Rehabilitation time in the mobilized group was reduced by an average of 15 days. The various functional outcomes were similar in the two groups.
In patients with Hansen's disease, an early active mobilization protocol for foot-drop correction has no added risk of tendon pullout and provides similar functional outcomes compared with immobilization. Early mobilization had the advantage of earlier restoration of independent walking.
Level I, therapeutic study. See Guidelines for Authors for a complete description of levels of evidence.
肌腱转移术后的固定一直是常规的术后管理。最近的几项研究表明，早期活动不会增加肌腱拔出。
问题/目的：为了证实这些研究，我们确定与固定相比，早期主动活动后足下垂矫正的肌腱转移是否会（1）具有类似的低肌腱插入拔出率，（2）减少康复时间，（3）导致类似的功能结果（主动踝关节背屈、跖屈、ROM、步行能力、斯坦莫尔评分和功能问题的解决）。
我们将 24 例手术矫正的足下垂畸形患者随机分为术后早期活动组（5 天内主动活动，n = 13）或 4 周固定组（29 天内主动活动，n = 11）。在两组中，胫骨后肌腱均转移至趾长伸肌和趾短伸肌以矫正足下垂。康复时间定义为从手术到康复出院独立行走的时间。两组的最低随访时间均为 16 个月（平均 19 个月；范围，16-38 个月）。
我们在两组中均未观察到肌腱拔出的病例。活动组的康复时间平均减少了 15 天。两组的各种功能结果相似。
在麻风病患者中，早期主动活动方案用于矫正足下垂不会增加肌腱拔出的风险，并提供与固定相似的功能结果。早期活动的优点是更早恢复独立行走。
一级，治疗研究。有关证据水平的完整描述，请参见作者指南。
