Johnson Shepard P, Kelley Brian P, Waljee Jennifer F, Chung Kevin C
Department of Surgery, Section of Plastic Surgery, University of Michigan Medical School, Ann Arbor, Mich.
Institute of Reconstructive Plastic Surgery, Ascension Seton Healthcare and Department of Surgery and Perioperative Care, Dell Medical School, Austin, Tex.
Plast Reconstr Surg Glob Open. 2020 Dec 21;8(12):e3278. doi: 10.1097/GOX.0000000000003278. eCollection 2020 Dec.
This population-based study aimed to define how time to hand therapy following isolated zone II flexor tendon repairs impacts complications and secondary procedures.
Insurance claims from the Truven MarketScan Databases were used to evaluate outcomes after isolated zone II flexor tendon repairs between January 2009 and October 2015. Cohorts differing in time to hand therapy were compared to evaluate the impact on complications, reoperation, and number of therapy sessions. Secondary outcomes analyzed how the number of therapy sessions affected rates of reoperation.
Hand therapy was identified in 82% of patients (N = 2867) following tendon reconstruction. Therapy initiation occurred within 1 week, 1-4 weeks, and after 4 weeks in 56%, 35%, and 9% of patients, respectively. Univariate analysis showed no difference in non-tendinous complications (27%, 30%, 29%; = 0.29) or tendon rupture rates (13%, 13%, 10%; = 0.42) within 90 days between cohorts. Multivariable analysis showed no difference in rates of tenolysis (6.3%, 6%, 4.4%; > 0.01). In the early initiation cohort, >23 hand therapy sessions were associated with the highest rates of tenolysis (19%).
Despite being a common fear of hand surgeons, early initiation of hand therapy was not associated with increased tendon rupture rates. Although delayed therapy is a concern for tendon scarring, it did not confer a higher risk of tenolysis. Complication rates do not appear to correlate with timing of hand therapy. Therefore, hand surgeons should promote early mobility following isolated flexor tendon injuries given the known functional outcome benefits.
这项基于人群的研究旨在确定孤立的Ⅱ区屈指肌腱修复术后接受手部治疗的时间如何影响并发症和二次手术。
使用来自Truven MarketScan数据库的保险理赔数据来评估2009年1月至2015年10月期间孤立的Ⅱ区屈指肌腱修复术后的结果。比较手部治疗时间不同的队列，以评估对并发症、再次手术和治疗次数的影响。次要结果分析了治疗次数如何影响再次手术率。
在肌腱重建术后，82%的患者（N = 2867）接受了手部治疗。分别有56%、35%和9%的患者在1周内、1 - 4周内和4周后开始治疗。单因素分析显示，各队列在90天内的非肌腱并发症（27%、30%、29%；P = 0.29）或肌腱断裂率（13%、13%、10%；P = 0.42）没有差异。多变量分析显示，肌腱松解率（6.3%、6%、4.4%；P > 0.01）没有差异。在早期开始治疗的队列中，超过23次手部治疗与最高的肌腱松解率（19%）相关。
尽管手部外科医生普遍担心，但早期开始手部治疗与肌腱断裂率增加无关。虽然延迟治疗会担心肌腱瘢痕形成，但它并没有带来更高的肌腱松解风险。并发症发生率似乎与手部治疗的时间无关。因此，鉴于已知的功能结局益处，手部外科医生应在孤立的屈指肌腱损伤后促进早期活动。
