From the Department of Orthopaedic Surgery, National Health Insurance Service, Ilsan Hospital; the Department of Orthopaedic Surgery, College of Medicine, Yonsei University; Hand and Microsurgery, Duson Hospital; the Department of Orthopaedic Surgery, Catholic-Kwandong University; and the Biostatistics Collaboration Unit, Yonsei University College of Medicine.
Plast Reconstr Surg. 2020 Mar;145(3):723-733. doi: 10.1097/PRS.0000000000006611.
The wide-awake approach enables surgeons to perform optimal tensioning of a transferred tendon intraoperatively. The authors hypothesized that the extensor indicis proprius-to-extensor pollicis longus tendon transfer using the wide-awake approach would yield better results than conventional surgery.
A retrospective analysis was performed of the prospectively collected data of 29 consecutive patients who underwent extensor indicis proprius-to-extensor pollicis longus tendon transfer. Patients were treated with the wide-awake approach (group A, n = 11) and conventional surgery under general anesthesia (group B, n = 18). The groups were compared retrospectively for thumb interphalangeal and metacarpophalangeal joint motion, grip and pinch strength, specific extensor indicis proprius-to-extensor pollicis longus evaluation method (SEEM), and Disabilities of the Arm, Shoulder and Hand questionnaire score at 6 weeks and 2, 4, 6, and 12 months postoperatively.
Group A showed significantly better interphalangeal joint flexion and total arc of motion at 6 weeks and 2, 4, and 6 months, and significantly better metacarpophalangeal joint flexion and total arc of motion at all time points. Interphalangeal and metacarpophalangeal joint extension showed no difference at all time points. Group A showed significantly better specific extensor indicis proprius-to-extensor pollicis longus evaluation method scores at 2 and 4 months, and Disabilities of the Arm, Shoulder and Hand questionnaire scores at 4, 6, and 12 months. Grip and pinch strength showed no difference at all time points. The complication rate and duration until return to work were not different between groups.
Compared with the conventional approach, the wide-awake approach showed significantly better results in the thumb's range of motion and functional outcomes, especially in the early postoperative periods.
CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, III.
清醒手术使外科医生能够在术中对转移肌腱进行最佳的张力调整。作者假设，使用清醒手术进行示指固有伸肌腱到拇长展肌腱转移的效果要好于传统手术。
对 29 例连续接受示指固有伸肌腱到拇长展肌腱转移的患者前瞻性收集的数据进行回顾性分析。患者接受清醒手术（A 组，n = 11）和全身麻醉下传统手术（B 组，n = 18）治疗。比较两组术后 6 周及 2、4、6、12 个月时拇指指间关节和掌指关节活动度、握力和捏力、特定示指固有伸肌腱到拇长展肌腱评估方法（SEEM）和上肢功能障碍问卷（DASH）评分。
A 组在术后 6 周和 2、4、6 个月时指间关节屈曲度和总活动度明显更好，在所有时间点时掌指关节屈曲度和总活动度明显更好。指间关节和掌指关节伸展度在所有时间点均无差异。A 组在术后 2 和 4 个月时 SEEM 评分和 DASH 评分明显更好，在术后 4、6 和 12 个月时 DASH 评分明显更好。握力和捏力在所有时间点均无差异。两组并发症发生率和恢复工作时间无差异。
与传统方法相比，清醒手术在拇指活动度和功能结果方面具有明显优势，尤其是在术后早期。
临床问题/证据水平：治疗性，III 级。
