Elliot D, Giesen T
Department of Hand Surgery, St. Andrew's Centre for Plastic Surgery, Broomfield Hospital, Chelmsford, Essex, UK.
Indian J Plast Surg. 2013 May;46(2):312-24. doi: 10.4103/0970-0358.118610.
This review describes the biological problems faced by those managing primary flexor tendon injuries and explains why these problems still thwart attempts to achieve normal, or near normal, function after this injury, despite a century of surgical effort. It considers the historical background of the early 20(th) century attempts to improve the results and analyses the clinical usefulness of more recent research into tendon core and circumferential suture modification, including the authors' work in this field, and changes in post-operative mobilisation over the last 50 years. More recent manipulation of the sheath to improve results and the future possibility of manipulation of adhesions are discussed. It also discusses other factors, e.g., the patient, the experience of the surgeon, the use of therapists, the timing of repair, complex injuries, injuries in zones other than zone 2, which can have a bearing on the results and considers how these can be modified to avoid an unfavourable outcome.
这篇综述描述了处理原发性屈指肌腱损伤者所面临的生物学问题，并解释了尽管经过一个世纪的外科努力，为何这些问题仍然阻碍人们在损伤后实现正常或接近正常功能的尝试。它考量了20世纪早期为改善治疗效果所做尝试的历史背景，并分析了近期关于肌腱核心和环形缝线改良研究的临床实用性，包括作者在该领域的工作，以及过去50年术后活动方案的变化。文中讨论了近期为改善治疗效果对腱鞘所做的处理，以及未来处理粘连的可能性。它还讨论了其他因素，例如患者、外科医生的经验、治疗师的使用、修复时机、复杂损伤、2区以外区域的损伤，这些因素会对治疗效果产生影响，并思考如何对这些因素进行调整以避免不良后果。
