Hamilton, Ontario, Canada From the Division of Plastic Surgery, the Departments of Surgery and Clinical Epidemiology and Biostatistics, and the Surgical Outcomes Research Center, McMaster University.
Plast Reconstr Surg. 2011 Apr;127(4):1583-1592. doi: 10.1097/PRS.0b013e318208d28e.
Restoration of function following flexor tendon repair in zone II represents a difficult clinical problem. Despite many publications on rehabilitation methods, there exists no consensus as to which method is superior. This study was undertaken to determine which flexor tendon rehabilitation protocol provides the best outcome after surgical repair in zone II.
Electronic databases were searched for articles published between 1970 and 2009. The population included patients aged 5 years and older who sustained a flexor tendon laceration in zone II. The primary outcome was rupture rate. Secondary outcomes were range of motion and quality of life. The following protocols and their variations were considered: passive flexion and active extension protocols (Kleinert type protocols), controlled passive motion protocols (Duran type protocols), combination of the Kleinert and Duran protocols, and early active motion protocols.
Seventy-nine articles were identified. Fifteen studies met the inclusion criteria. The mean rate of rupture was lowest in the combined Kleinert and Duran protocols (2.3 percent) and highest in the Kleinert protocols (7.1 percent). No statistically significant differences were found. The combined Kleinert and Duran protocols and the early active motion protocols exhibited the highest proportion of digits with excellent or good results using the Strickland and Buck-Gramcko systems. One study included a quality-of-life assessment-meaningful comparison was not possible.
Both early active motion protocols and combined Kleinert and Duran protocols result in low rates of tendon rupture and acceptable range of motion following flexor tendon repair in zone II. Future studies should include quality-of-life measurements using validated scales.
在 II 区修复屈肌腱后恢复功能是一个具有挑战性的临床问题。尽管有许多关于康复方法的出版物，但哪种方法更优仍存在争议。本研究旨在确定哪种屈肌腱康复方案在 II 区修复后能获得最佳效果。
检索了 1970 年至 2009 年期间发表的文章。纳入的人群为年龄在 5 岁及以上、在 II 区发生屈肌腱撕裂的患者。主要结局是断裂率。次要结局为活动度和生活质量。考虑了以下方案及其变化：被动屈曲和主动伸展方案（Kleinert 型方案）、控制性被动运动方案（Duran 型方案）、Kleinert 和 Duran 方案的组合以及早期主动运动方案。
共确定了 79 篇文章。15 项研究符合纳入标准。Kleinert 方案的平均断裂率最高（7.1%），Kleinert 和 Duran 联合方案的断裂率最低（2.3%）。差异无统计学意义。Strickland 和 Buck-Gramcko 系统显示，Kleinert 和 Duran 联合方案和早期主动运动方案的手指结果优良率最高。有一项研究包括了生活质量评估，但无法进行有意义的比较。
早期主动运动方案和 Kleinert 和 Duran 联合方案均可降低 II 区屈肌腱修复后肌腱断裂的发生率，并获得可接受的活动度。未来的研究应使用经过验证的量表进行生活质量测量。
