Niigata Hand Surgery Foundation, Niigata, Japan.
Niigata Hand Surgery Foundation, Niigata, Japan.
J Orthop Sci. 2021 Sep;26(5):792-797. doi: 10.1016/j.jos.2020.08.003. Epub 2020 Sep 9.
There have been few studies regarding primary flexor tendon repair of the thumb following early active mobilization, whereas there have been multiple such studies of the finger. This study examined the outcomes of patients who underwent early active mobilization after primary repair of the flexor pollicis longus tendon.
This study was a retrospective case series. Between 1993 and 2019, 17 thumbs of 17 consecutive patients with complete flexor pollicis longus tendon lacerations were treated using the Yoshizu #1 technique, followed by early active mobilization. The mean time between injury and primary flexor tendon repair was 2 days. Two thumbs had zone T1 injuries and 15 had zone T2 injuries. Mobilization of the thumb began on the first postoperative day with a combination of active extension and passive and active flexion. The mean follow-up period was 8 months. The percentage of total active motion of the thumb was regarded as the sum of the active motion of the two joints, divided by 140°. Functional outcomes were graded in accordance with the Strickland criteria.
Three repair ruptures occurred in thumbs treated by inexperienced surgeons. Excluding tendon ruptures, the mean percentage of total active motion of the thumb was 83%. The mean active flexion of the interphalangeal and metacarpophalangeal joints was 62° and 64°. The mean extension deficit was 8.8° at the interphalangeal joint and 7.5° at the metacarpophalangeal joint. According to Strickland's criteria, repairs to eight thumbs were ranked excellent, three were good, one was fair, and five were poor.
Our results are not inferior to the findings of previous reports regarding early postoperative mobilization after primary flexor pollicis longus tendon repair, in terms of the acquisition of active thumb motion. Poor outcomes result from repair rupture and increased extension deficits of the interphalangeal and metacarpophalangeal joints.
虽然有许多关于手指屈肌腱修复后早期主动活动的研究，但对于拇指屈肌腱修复后早期主动活动的研究却很少。本研究探讨了采用 Yoshizu #1 技术修复拇长屈肌腱断裂后早期主动活动的患者的治疗效果。
本研究为回顾性病例系列研究。1993 年至 2019 年，采用 Yoshizu #1 技术治疗了 17 例 17 个完全性拇长屈肌腱断裂患者的拇指，术后早期进行主动活动。肌腱损伤至初次修复的平均时间为 2 天。2 个拇指为 T1 区损伤，15 个拇指为 T2 区损伤。术后第 1 天开始进行拇指的主动伸展和被动及主动屈曲活动，开始主动活动。平均随访时间为 8 个月。拇指总主动活动度的百分比被视为两个关节主动活动度之和除以 140°。功能结果按照 Strickland 标准进行分级。
3 个拇指由经验不足的医生治疗，出现修复断裂。不包括肌腱断裂，拇指总主动活动度的平均百分比为 83%。指间关节和掌指关节的平均主动屈曲度分别为 62°和 64°。指间关节的平均伸直位缺失为 8.8°，掌指关节的平均伸直位缺失为 7.5°。根据 Strickland 标准，8 个拇指修复效果为优，3 个为良，1 个为可，5 个为差。
在获得主动拇指运动方面，我们的结果并不逊于既往关于拇长屈肌腱修复后早期术后活动的研究结果。较差的结果是由于修复断裂和指间关节及掌指关节的伸直位缺失增加所致。
