Bigorre N, Delaquaize F, Degez F, Celerier S
Centre de la main, 47, rue de la Foucaudière, 49000 Trélazé, France.
Hôpitaux universitaire de Genève, service de physiothérapie, rééducation de la main, 4, rue Gabrielle-Perret-Gentil, 1211 Genève 14, Switzerland.
Hand Surg Rehabil. 2018 Oct;37(5):281-288. doi: 10.1016/j.hansur.2018.05.005. Epub 2018 Jun 20.
The repair of flexor tendon lesions in zone 2 remains a highly controversial subject in hand surgery. Currently, there is no consensus about the management of these lesions intra- and postoperatively, but the literature suggests that a solid suture will allow early active motion. We hypothesized that the management of flexor tendon injury in zone 2 varies widely. Two online surveys were conducted with surgeons and hand therapists. The questions captured the demographics of the surveyed population, surgical technique, common complications, postoperative management (duration of immobilization, type of splint, rehabilitation techniques and principles of self-rehabilitation). The responses were compared to current literature data. We collected 366 responses to the "surgery" survey and 206 responses to "rehabilitation" survey. Most surgeons performed suture repair with at least 4 strands (75.9%). Active rehabilitation protocols were used in 48.9% of cases. The "rehabilitation" survey underlined the lack of information provided to therapists by surgeons. Therapists used active protocols in 79.7% of cases. This study found a large variation in the management of flexor tendon injuries, which is not always consistent with current published recommendations. Ideally, the suture repair should be a 4-strand pattern with an epitendinous circumferential suture and a release of the pulley in the suture area. Mobilization and rehabilitation should be started on the 3rd day using an active protocol.
在手部外科中，2区屈指肌腱损伤的修复仍是一个极具争议的话题。目前，对于这些损伤在术中及术后的处理尚无共识，但文献表明牢固的缝合可允许早期主动活动。我们推测2区屈指肌腱损伤的处理方式差异很大。我们对外科医生和手部治疗师进行了两项在线调查。问题涵盖了被调查人群的人口统计学信息、手术技术、常见并发症、术后处理（制动时间、夹板类型、康复技术及自我康复原则）。将这些回答与当前文献数据进行了比较。我们收集到了366份针对“手术”调查的回复以及206份针对“康复”调查的回复。大多数外科医生采用至少4股线进行缝合修复（75.9%）。48.9%的病例采用了主动康复方案。“康复”调查强调了外科医生向治疗师提供的信息不足。治疗师在79.7%的病例中采用了主动方案。本研究发现屈指肌腱损伤的处理方式差异很大，这并不总是与当前发表的建议一致。理想情况下，缝合修复应采用4股线模式，进行腱周环行缝合，并在缝合区域松解滑车。应在术后第3天采用主动方案开始活动和康复。
