McMaster University, Hamilton, ON, Canada.
University of Ottawa, ON, Canada.
Hand (N Y). 2022 Mar;17(2):278-284. doi: 10.1177/1558944720926651. Epub 2020 May 26.
Pediatric outcomes after flexor tendon repairs are variable, and evidence in the literature remains scarce. Repair of pediatric flexor tendon injuries was reviewed over a 10-year period (2005-2015). Data collection consisted of patient demographics, injury characteristics, anesthetic choice, repair technique, rehabilitation protocol, American Society for Surgery of the Hand Total Active Motion (TAM) scores, and complications. There were 109 patients included in our study, with a total of 162 digits injured and 235 flexor tendon injuries. The mean age was 12 ± 4.6 years. The small finger (48 of 162; 30%) and the flexor digitorum profundus tendon (126 of 235) were the most commonly injured. The mechanism of injury was mainly from a knife (46 of 109; 42.2%) in zone II (82 of 159; 52%). Injuries were mostly repaired under general anesthetic (61 of 104; 56%). The Kessler technique was the predominant repair mechanism (111 of 225 repairs; 49%). Most patients (103 of 109; 95%) had excellent or good TAM scores with 5 postoperative ruptures reported. The most common complication was stiffness (17 of 121 complications; 14%), with most patients having no complications ( 74 of 109 patients; 68%). Patients were commonly immobilized (mean 8.4 ± 10.3 weeks) with a splint (93 of 109; 85%). There were 85 patients who followed a postoperative rehabilitation protocol for 12 ± 18 weeks. Patient demographics, time of repair, injury characteristics, anesthetic choice, and rehabilitation protocol were not significantly correlated with TAM scores or complication rates. Pediatric tendon injuries have good outcomes with no predictive factors identified. Surgical repairs performed under local anesthetic have similar outcomes without increased rates of complications, but remain underused in the pediatric population.
儿童屈肌腱修复后的预后各不相同，文献中的证据仍然很少。对 10 年来（2005-2015 年）的儿童屈肌腱损伤修复进行了回顾。数据收集包括患者人口统计学、损伤特征、麻醉选择、修复技术、康复方案、美国手外科学会总主动活动度（TAM）评分和并发症。本研究共纳入 109 例患者，共 162 个手指受伤，235 个屈肌腱损伤。平均年龄为 12±4.6 岁。小指（162 个中的 48 个；30%）和深屈肌腱（235 个中的 126 个）是最常受伤的部位。受伤机制主要为刀伤（109 例中的 46 例；42.2%），在 II 区（159 个中的 82 个；52%）。损伤主要在全身麻醉下修复（104 例中的 61 例；56%）。Kessler 技术是主要的修复机制（225 个修复中的 111 个；49%）。大多数患者（109 例中的 103 例；95%）TAM 评分优秀或良好，报告术后 5 例断裂。最常见的并发症是僵硬（121 例并发症中的 17 例；14%），大多数患者无并发症（109 例患者中有 74 例；68%）。患者通常用夹板固定（平均 8.4±10.3 周）（109 例中的 93 例；85%）。有 85 例患者遵循术后康复方案 12±18 周。患者人口统计学、修复时间、损伤特征、麻醉选择和康复方案与 TAM 评分或并发症发生率无显著相关性。儿童肌腱损伤的预后良好，未发现有预测因素。局部麻醉下进行的手术修复具有相似的效果，且并发症发生率没有增加，但在儿童人群中仍未得到广泛应用。
