Chalmer Joelle, Blakeway Megan, Adams Zoe, Milan Stephen J
Hand Therapy, Therapy Department, St George’s Healthcare NHS Trust, London, UK.
Cochrane Database Syst Rev. 2013 Feb 28;2013(2):CD009030. doi: 10.1002/14651858.CD009030.pub2.
Immobilisation and early motion (protected or unrestricted) are both used following hyperextension injuries to the proximal interphalangeal (PIP) joint of the finger.
To assess the effects of conservative interventions (non-surgical management) for treating hyperextension injuries of the proximal interphalangeal joints of the fingers.
We searched the Cochrane Bone, Joint and Muscle Trauma Group Specialised Register (January 2012), the Cochrane Central Register of Controlled Trials (in The Cochrane Library 2012, Issue 1), MEDLINE (1946 to January Week 2 2012), EMBASE (1980 to 2012 Week 03), CINAHL (1950 to 24 January 2012), PEDro (1929 to March 2012), trial registers and reference lists of articles.
Randomised and quasi-randomised studies comparing immobilisation/protected mobilisation/unrestricted mobilisation in participants with PIP joint hyperextension injuries managed non-surgically.
Two review authors independently assessed risk of bias and extracted data. There was no pooling of data.
Three trials involving 366 people were identified. All three trials, which were over 15 years old, were methodologically flawed with unclear or high risk of bias. None of the studies reported on self assessment of function. One trial compared unrestricted mobility with immobilisation; one trial compared protected mobilisation with immobilisation; and the remaining trial compared immobilisation for one week versus three weeks. None of these trials found statistically significant differences between their intervention groups in various measures of poor outcome, pain and range of movement at six months follow-up. This lack of difference applied at three years for the comparison between unrestricted mobility with immobilisation.
AUTHORS' CONCLUSIONS: There is insufficient evidence from trials testing the need for, and the extent and duration of, immobilisation to inform on the key conservative management decisions for treating hyperextension injuries of the proximal interphalangeal joints.
手指近端指间关节（PIP）过伸损伤后，固定和早期活动（保护性或非限制性）均有应用。
评估保守干预措施（非手术治疗）对手指近端指间关节过伸损伤的治疗效果。
我们检索了Cochrane骨、关节与肌肉创伤组专业注册库（2012年1月）、Cochrane对照试验中心注册库（《Cochrane图书馆》2012年第1期）、MEDLINE（1946年至2012年1月第2周）、EMBASE（1980年至2012年第3周）、CINAHL（1950年至2012年1月24日）、PEDro（1929年至2012年3月）、试验注册库以及文章的参考文献列表。
比较非手术治疗的PIP关节过伸损伤患者采用固定/保护性活动/非限制性活动的随机和半随机研究。
两位综述作者独立评估偏倚风险并提取数据。未进行数据合并。
共纳入3项试验，涉及366人。这3项试验均开展于15年以上，在方法学上存在缺陷，偏倚风险不明确或较高。没有研究报告功能的自我评估情况。一项试验比较了非限制性活动与固定；一项试验比较了保护性活动与固定；其余一项试验比较了固定一周与三周的效果。在6个月随访时，这些试验均未发现各干预组在各种不良结局、疼痛和活动范围测量指标上存在统计学显著差异。在三年时，非限制性活动与固定的比较也未发现差异。
关于固定的必要性、程度和持续时间的试验证据不足，无法为手指近端指间关节过伸损伤的关键保守治疗决策提供依据。
