Altobelli Grant G, Conneely Stacy, Haufler Christina, Walsh Maura, Ruchelsman David E
Division of Hand and Upper Extremity Surgery, Tufts Medical Center and Newton-Wellesley Hospital/Tufts University School of Medicine, Boston, MA02462, USA.
J Hand Surg Am. 2013 Jun;38(6):1079-83. doi: 10.1016/j.jhsa.2013.03.031.
Biomechanical evidence has demonstrated that the running interlocking horizontal mattress (RIHM) repair for extensor tendon lacerations is significantly stronger, with higher ultimate load to failure and less tendon shortening compared with other techniques. We investigated the efficacy and safety of primary extensor tendon repair using the RIHM repair technique in the fingers followed by the immediate controlled active motion protocol, and in the thumb followed by a dynamic extension protocol.
We conducted a retrospective review of all patients undergoing extensor tendon repair from August 2009 to April 2012 by single surgeon in an academic hand surgery practice. The inclusion criteria were simple extensor tendon lacerations in digital zones IV and V and thumb zones TI to TIV and primary repair performed using the RIHM technique. We included 8 consecutive patients with 9 tendon lacerations (3 in the thumb). One patient underwent a concomitant dorsal hand rotation flap for soft tissue coverage. We used a 3-0 nonabsorbable braided suture to perform a running simple suture in 1 direction to obtain a tension-free tenorrhaphy, followed by an RIHM corset-type suture using the same continuous strand in the opposite direction. Average time to surgery was 10 days (range, 3-33 d). Mean follow-up was 15 weeks (range, 10-26 wk). We applied the immediate controlled active motion protocol to all injuries except those in the thumb, where we used a dynamic extension protocol instead.
Using the criteria of Miller, all 9 tendon repairs achieved excellent or good results. There were no tendon ruptures or extensor lags. No patients required secondary surgery for tenolysis or joint release. No wound complications occurred.
The RIHM technique for primary extensor tendon repairs in zone IV and V and T1 to TIV is safe, allows for immediate controlled active motion in the fingers and an immediate dynamic extension protocol in the thumb, and achieves good to excellent functional outcomes. These clinical outcomes support prior biomechanical data.
TYPE OF STUDY/LEVEL OF EVIDENCE: Therapeutic IV.
生物力学证据表明，与其他技术相比，用于修复伸肌腱撕裂的连续交锁水平褥式缝合法（RIHM）显著更强，具有更高的最终破坏载荷且肌腱缩短更少。我们研究了采用RIHM修复技术对手指伸肌腱进行一期修复并立即采用可控主动活动方案，以及对拇指伸肌腱进行一期修复并采用动态伸展方案的疗效和安全性。
我们对2009年8月至2012年4月在一所学术性手外科机构由同一位外科医生进行伸肌腱修复的所有患者进行了回顾性研究。纳入标准为手指IV区和V区以及拇指TI至TIV区的单纯伸肌腱撕裂伤，并采用RIHM技术进行一期修复。我们纳入了8例连续患者，共9处肌腱撕裂伤（3处在拇指）。1例患者同时接受了手背旋转皮瓣覆盖软组织。我们使用3-0不可吸收编织缝线沿一个方向进行连续单纯缝合以获得无张力腱缝术，随后使用同一连续缝线沿相反方向进行RIHM束腰式缝合。平均手术时间为10天（范围3 - 33天）。平均随访时间为15周（范围10 - 26周）。除拇指损伤采用动态伸展方案外，我们对所有损伤均采用立即可控主动活动方案。
根据米勒标准，所有9处肌腱修复均取得了优或良的结果。没有肌腱断裂或伸肌滞后。没有患者需要进行二次手术以松解粘连或松解关节。未发生伤口并发症。
用于IV区和V区以及T1至TIV区伸肌腱一期修复的RIHM技术是安全的，允许手指立即进行可控主动活动以及拇指立即采用动态伸展方案，并取得良好至优异的功能结果。这些临床结果支持了先前的生物力学数据。
研究类型/证据水平：治疗性IV级。
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