Department of Rehabilitation Medicine and Physical Therapy, Erasmus MC, P.O. Box 2040, 3000 CA Rotterdam, The Netherlands.
J Bone Joint Surg Am. 2012 Mar 7;94(5):394-402. doi: 10.2106/JBJS.J.01521.
Different mobilization protocols have been proposed for rehabilitation after hand flexor tendon repair to provide tendon excursion sufficient to prevent adhesions. Several cadaver studies have shown that the position of the neighboring fingers influences tendon excursions of the injured finger. We hypothesized that the positions of adjacent fingers influence the long finger flexor digitorum profundus tendon excursion, measured both absolutely and relative to the surrounding tissue of the tendon.
Long finger flexor digitorum profundus tendon excursions and surrounding tissue movement were measured in zone V in eleven healthy subjects during three different rehabilitation protocols and two experimental models: (1) an active four-finger mobilization protocol, (2) a passive four-finger mobilization protocol, (3) a modified Kleinert mobilization protocol, (4) an experimental modified Kleinert flexion mobilization model, and (5) an experimental modified Kleinert extension mobilization model. Tendon excursions were measured with use of a frame-to-frame analysis of high-resolution ultrasound images.
The median absolute long finger flexor digitorum profundus tendon excursions were 23.4, 17.8, 10.0, 13.9, and 7.6 mm for the active four-finger mobilization protocol, the passive four-finger mobilization protocol, the modified Kleinert mobilization protocol, the experimental modified Kleinert flexion mobilization model, and the experimental modified Kleinert extension mobilization model, respectively, and these differences were all significant (p ≤ 0.041). The corresponding relative flexor digitorum profundus tendon excursions were 11.2, 8.5, 7.2, 10.4, and 5.6 mm. Active four-finger mobilization protocol excursions were significantly (p = 0.013) greater than passive four-finger mobilization protocol excursions but were not significantly greater than experimental modified Kleinert flexion mobilization model excursions (p =0.213).
The present study demonstrated large and significant differences among the different rehabilitation protocols and experimental models in terms of absolute and relative tendon displacement. More importantly, the present study clearly demonstrated the influence of the position of the adjacent fingers on the flexor tendon displacement of the finger that is mobilized.
为了提供足以防止粘连的肌腱活动度，在手屈肌腱修复后的康复过程中已经提出了不同的动员方案。几项尸体研究表明，相邻手指的位置会影响受伤手指的肌腱活动度。我们假设相邻手指的位置会影响深屈指肌腱的长指肌腱活动度，无论是相对于肌腱周围组织的绝对位置还是相对位置。
在三个不同的康复方案和两个实验模型中，在 11 名健康受试者的第 V 区测量了深屈指长肌腱的活动度和周围组织的运动：（1）主动四指动员方案，（2）被动四指动员方案，（3）改良 Kleinert 动员方案，（4）实验性改良 Kleinert 弯曲动员模型，（5）实验性改良 Kleinert 伸展动员模型。使用高分辨率超声图像的逐帧分析来测量肌腱活动度。
主动四指动员方案、被动四指动员方案、改良 Kleinert 动员方案、实验性改良 Kleinert 弯曲动员模型和实验性改良 Kleinert 伸展动员模型的深屈指长肌腱的中位数绝对活动度分别为 23.4、17.8、10.0、13.9 和 7.6mm，这些差异均有统计学意义（p≤0.041）。相应的相对深屈肌腱活动度分别为 11.2、8.5、7.2、10.4 和 5.6mm。主动四指动员方案的活动度明显大于被动四指动员方案（p=0.013），但与实验性改良 Kleinert 弯曲动员模型的活动度无明显差异（p=0.213）。
本研究表明，不同的康复方案和实验模型在绝对和相对肌腱移位方面存在显著差异。更重要的是，本研究清楚地表明了相邻手指的位置对被动员手指的屈肌腱移位的影响。
