Department of Orthopaedic Surgery, Whangarei Hospital, Northland District Health Board, Whangarei, New Zealand.
Department of Surgery, Faculty of Medical and Health Sciences, The University of Auckland, Auckland, New Zealand.
ANZ J Surg. 2022 Jul;92(7-8):1668-1674. doi: 10.1111/ans.17398. Epub 2021 Dec 2.
Current evidence for flexor tendon repair management and outcomes performed at peripheral centres is unclear. Most studies are based on evidence from specialist hand centres. This study evaluated a peripheral hospital in New Zealand; where all flexor tendon repairs were performed by a generalist Orthopaedic service. The purpose of the study was to benchmark management and outcomes from a peripheral hospital in comparison to international standards.
A retrospective single-centre consecutive case series of Zones I and II flexor tendon repairs was extracted between 1 January 2014 and 1 January 2018. Medical records were used to evaluate management and outcomes of repairs. Hand therapy notes were used to evaluate rehabilitation protocols provided. The primary objective was to measure re-rupture and re-operation rates. Secondary objectives included auditing operative management and hand therapy compliance.
Forty-six patients (76 tendon repairs) were included in our final analysis. Mean follow up time to last clinical appointment was 11.8 weeks, and to last patient episode was 4.9 years. Most patients received timely surgery with a four-core repair using 3-0 or larger suture. All hand therapy followed a controlled active motion protocol. The re-operation rate was 19.6% (P = <0.05) and the re-rupture rate was 8.7% (P = 0.28).
Most flexor tendon injuries at this peripheral centre were managed according to international standards. However, high complication rates including re-operation and re-rupture occurred. Due to a lack of local comparison studies, confounding factors cannot be excluded as a contributor for these results.
目前外周中心进行的屈肌腱修复管理和结果的证据尚不清楚。大多数研究都是基于来自专业手部中心的证据。本研究评估了新西兰的一家外围医院；所有屈肌腱修复均由普通骨科服务完成。该研究的目的是将外围医院的管理和结果与国际标准进行基准比较。
从 2014 年 1 月 1 日至 2018 年 1 月 1 日，提取了 I 区和 II 区屈肌腱修复的回顾性单中心连续病例系列。使用病历评估修复的管理和结果。手部治疗记录用于评估提供的康复方案。主要目标是测量再断裂和再手术率。次要目标包括审核手术管理和手部治疗的依从性。
最终分析纳入了 46 名患者（76 根肌腱修复）。末次临床就诊的平均随访时间为 11.8 周，末次患者就诊时间为 4.9 年。大多数患者及时接受了手术治疗，采用四股修复，使用 3-0 或更大的缝线。所有手部治疗均遵循控制性主动运动方案。再手术率为 19.6%（P<0.05），再断裂率为 8.7%（P=0.28）。
该外周中心的大多数屈肌腱损伤均按照国际标准进行管理。然而，包括再手术和再断裂在内的高并发症发生率仍然存在。由于缺乏当地的比较研究，不能排除混杂因素对这些结果的影响。
