Jabir Shehab, Iwuagwu Fortune C
St Andrews Centre for Plastic Surgery and Burns, Broomfield Hospital, Chelmsford, United Kingdom.
Eplasty. 2014 Jan 17;14:e5. eCollection 2014.
Currently there is a multiplicity of postoperative mobility-based rehabilitation protocols following isolated digital nerve repair. The regime chosen appears to be dependent on the preference of the surgeon and unit rather than being evidence based. We aim to systematically review the current evidence to provide an insight toward formulating guidelines for best practice.
The study was carried out in accordance to the PRISMA statement for systematic reviews. Medline, Embase, CINAHL, Google Scholar, and Cochrane databases were searched from inception to June 2013. Key search terms used were as follows: "digital nerve," "rehabilitation," "mobilization/mobilization," "immobilization/immobilization," "splinting," "non-splinting," "brace," "repair," and "coaptation."
Four studies met the inclusion criteria and compared 2 of 3 regimens: complete immobilization, protected mobilization, and free mobilization. The primary outcome measured sensibility via 2-point discrimination and Semmes-Weinstein monofilament testing. There was no statistically significant difference in sensibility between either of the regimens. Secondary outcome measures included subjective measures such as cold intolerance and hyperesthesia, which also showed no significant difference between protocols. One study found that stiffness was increased, and return to work delayed, when a splinting protocol was employed.
Current evidence suggests that all 3 protocols are equivalent in their outcomes. The stiffness and delayed return to work associated with splinting protocols indicate that free mobilization protocols may have an advantage over them. However, the limitations of current evidence mean that the hand surgeon and therapist should choose a regimen from those discussed earlier, which is tailored to the needs of each individual patient until further evidence is gathered.
目前，单纯指神经修复术后有多种基于活动度的康复方案。所选用的方案似乎取决于外科医生和科室的偏好，而非基于证据。我们旨在系统回顾现有证据，为制定最佳实践指南提供见解。
本研究按照系统评价的PRISMA声明进行。检索了Medline、Embase、CINAHL、谷歌学术和Cochrane数据库，检索时间从建库至2013年6月。使用的主要检索词如下：“指神经”“康复”“活动/活动度”“固定/固定术”“夹板固定”“非夹板固定”“支具”“修复”和“吻合”。
四项研究符合纳入标准，比较了三种方案中的两种：完全固定、保护性活动和自由活动。主要结局通过两点辨别觉和Semmes-Weinstein单丝试验测量感觉功能。两种方案在感觉功能方面均无统计学显著差异。次要结局指标包括主观指标，如冷不耐受和感觉过敏，各方案之间也无显著差异。一项研究发现，采用夹板固定方案时，僵硬程度增加，重返工作岗位的时间延迟。
现有证据表明，所有三种方案的结局相当。与夹板固定方案相关的僵硬和重返工作岗位时间延迟表明，自由活动方案可能优于夹板固定方案。然而，现有证据的局限性意味着，手部外科医生和治疗师应从上述讨论的方案中选择一种，根据每位患者的需求进行调整，直至收集到更多证据。
