Faculty of Medicine, Department of Plastic, Reconstructive and Aesthetic Surgery, Hacettepe University, Sihhiye, 06080 Ankara, Turkey.
Faculty of Medicine, Department of Plastic, Reconstructive and Aesthetic Surgery, Hacettepe University, Sihhiye, 06080 Ankara, Turkey.
J Plast Reconstr Aesthet Surg. 2019 Apr;72(4):622-627. doi: 10.1016/j.bjps.2019.01.007. Epub 2019 Jan 14.
The repair of retracted flexor tendons is a challenging problem for hand surgeons. The tendon stump should be handled in an atraumatic manner because any microtrauma to the sheath and tendon can lead to poor functional outcomes.
Twenty-three patients with flexor zone 2 injuries and intraoperative finding of retracted tendons were randomly divided into two groups: endoscopic retrieval group and proximal incision group. A flexible endoscope and a flexible grasping forceps were used for endoscopic retrieval of the retracted flexor tendons. The groups were compared in terms of infection rate, neurovascular complications, regional pain, total range of active motion (TAM) and functional outcomes.
Age, gender, average preoperative pain and general pain perception scores were similar between the two groups. We found a significantly shorter duration of operation and better pain scores at 1-2 weeks in the endoscopic group than in the other group (p = 0.002 and p = 0.020, respectively). A significant difference in TAM was demonstrated between the groups at 3 to 5 weeks (p = 0.003).
The surgical procedure presented here has the advantages of direct visibility of the proximal tendon end and retrieval in an atraumatic manner, with better results and decreased morbidity. It is a promising approach and can be used as a routine procedure in retracted tendon cases.
手部外科医生在修复回缩的屈肌腱时面临着挑战。肌腱残端应采用无创伤的方式处理，因为鞘管和肌腱的任何微创伤都可能导致不良的功能结果。
23 例屈肌腱 2 区损伤患者术中发现肌腱回缩，随机分为内镜取出组和近端切开组。使用内镜和柔性抓钳取出回缩的屈肌腱。比较两组感染率、血管神经并发症、局部疼痛、总主动活动度（TAM）和功能结果。
两组患者的年龄、性别、术前平均疼痛和一般疼痛感知评分相似。我们发现内镜组的手术时间明显缩短，术后 1-2 周疼痛评分更好（p=0.002 和 p=0.020）。两组 TAM 在 3-5 周时有显著差异（p=0.003）。
本手术方法具有近端肌腱末端直视和微创取出的优点，效果更好，发病率更低。这是一种很有前途的方法，可以作为回缩肌腱病例的常规手术。
