Singer Georg, Zwetti Thomas, Amann Ruth, Castellani Christoph, Till Holger, Schmidt Barbara
Department of Paediatric and Adolescent Surgery, Medical University of Graz, Auenbruggerplatz 34, 8036 Graz, Austria.
Department of Paediatric and Adolescent Surgery, Medical University of Graz, Auenbruggerplatz 34, 8036 Graz, Austria.
J Plast Reconstr Aesthet Surg. 2017 Jul;70(7):908-913. doi: 10.1016/j.bjps.2017.03.014. Epub 2017 Apr 8.
The ideal rehabilitation regimen of paediatric flexor tendon injuries of the hand is discussed controversially. In this study, the clinical outcome of paediatric patients with flexor tendon injuries treated with a dynamic postoperative protocol was assessed. All children with flexor tendon injuries of the hand who were treated by a dynamic postoperative protocol between 1999 and 2011 were included. Patients were invited for a follow-up examination consisting of clinical examination, the TAM and Buck-Gramcko scores, and the linear measurement system. In total, 144 patients (mean age 9.1 years, range 1-17 years) with 267 flexor tendon injuries (128 flexor digitorum superficialis (FDS), 126 flexor digitorum profundus (FDP) and 13 flexor pollicis longus (FPL)) of 191 digits were treated. Of them, 43% (n = 62; 49 male, 13 female) with 88 digits (thumb n = 4, index finger n = 17, middle finger n = 25, ring finger n = 20, small finger n = 22) with 123 injured tendons (FDS n = 62, FDP n = 57, FPL n = 4) were included in the follow-up at a mean post-operative interval of 7.2 years (range 1-13 years). Using the Total Active Motion (TAM) score, an excellent and good outcome could be achieved in 41% and 48% of the patients, respectively. The zone of injury did not influence the objective outcome measures. Subjective and objective outcomes were not statistically different between young children (≤6 years) and older children (>6 years). The present study demonstrates good to excellent outcome in a large cohort of paediatric patients with flexor tendon injuries of the hand treated with a dynamic mobilisation protocol irrespective of patient age.
小儿手部屈指肌腱损伤的理想康复方案存在争议。在本研究中，评估了采用动态术后方案治疗的小儿屈指肌腱损伤患者的临床结果。纳入了1999年至2011年间所有采用动态术后方案治疗的小儿手部屈指肌腱损伤患者。邀请患者进行随访检查，包括临床检查、TAM和Buck-Gramcko评分以及线性测量系统。总共治疗了191个手指的267处屈指肌腱损伤患者144例（平均年龄9.1岁，范围1至17岁）。其中，43%（n = 62；男49例，女13例）的88个手指（拇指n = 4，示指n = 17，中指n = 25，环指n = 20，小指n = 22）有123处肌腱损伤（指浅屈肌（FDS）n = 62，指深屈肌（FDP）n = 57，拇长屈肌（FPL）n = 4）在平均术后7.2年（范围1至13年）时纳入随访。使用总主动活动度（TAM）评分，分别有41%和48%的患者获得了优和良的结果。损伤区域不影响客观结果指标。幼儿（≤6岁）和大龄儿童（>6岁）之间的主观和客观结果无统计学差异。本研究表明，采用动态活动方案治疗的大量小儿手部屈指肌腱损伤患者，无论患者年龄如何，均可获得良好至优异的结果。
