Department of Hand Surgery, Sahlgrenska University Hospital, Gothenburg, Sweden; Department of Hand Surgery, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg.
Department of Occupational Therapy and Physiotherapy, Hand Rehabilitation, Sahlgrenska University Hospital, Gothenburg, Sweden.
J Hand Surg Am. 2022 Apr;47(4):348-357. doi: 10.1016/j.jhsa.2021.11.031. Epub 2022 Feb 18.
Mobilization after flexor tendon repair in fingers has been a subject of debate for several years. Many hand surgery clinics have turned to early active mobilization. However, there is no strong scientific evidence suggesting that early active mobilization produces a better range of motion (ROM) than the Kleinert regimen when place and hold is added. Therefore, the purpose of this prospective randomized trial was to investigate whether active mobilization is superior to passive mobilization with place and hold after flexor tendon repair in the fingers. Our hypothesis was that patients who follow the active mobilization protocol have a better ROM than those who follow the passive protocol with place and hold.
Sixty-four patients with a flexor tendon injury in zone I or II were included. After surgery, randomization to undergo either active mobilization or passive mobilization with place and hold was performed. The patients were followed-up for 12 months using outcome measurements, including ROM, strength, rupture frequency, Disabilities of the Arm, Shoulder and Hand score, ABILHAND questionnaire, and performance on the Purdue Pegboard test.
We were unable to find any significant difference between the 2 groups for any of the outcome measurements, ROM, grip strength, key pinch, rupture frequency, Disabilities of the Arm, Shoulder and Hand score, ABILHAND questionnaire, and performance on the Purdue Pegboard test.
The outcomes were equivalent for both the mobilization groups.
TYPE OF STUDY/LEVEL OF EVIDENCE: Therapeutic I.
手指屈肌腱修复后的活动方案一直存在争议。许多手外科诊所已经转向早期主动活动。然而，没有强有力的科学证据表明，与 Kleinert 方案相比，早期主动活动在增加位置保持（place and hold）时能产生更好的关节活动度（ROM）。因此，本前瞻性随机试验的目的是研究主动活动是否优于手指屈肌腱修复后的被动活动（place and hold）。我们的假设是，遵循主动活动方案的患者的 ROM 比遵循被动方案（place and hold）的患者更好。
纳入 64 例 I 区或 II 区屈肌腱损伤患者。手术后，随机分为主动活动组或被动活动（place and hold）组。通过 ROM、力量、断裂频率、上肢功能障碍残疾问卷（Disabilities of the Arm, Shoulder and Hand，DASH）评分、ABILHAND 问卷和 Purdue 钉板测试等结果测量对患者进行 12 个月的随访。
我们未发现 2 组在任何结果测量（ROM、握力、关键捏力、断裂频率、DASH 评分、ABILHAND 问卷和 Purdue 钉板测试）上存在显著差异。
2 种活动方案的结果相当。
研究类型/证据水平：治疗性 I 级。
