Huynh Minh Nq, Karir Aneesh, Kim Patrick J
McMaster University, Department of Surgery, Division of Plastic Surgery, 1280 Main Street West, Hamilton, Ontario, L8S 4L8, Canada.
University of Manitoba, Department of Surgery, Division of Plastic and Reconstructive Surgery, 66 Chancellors Circle, Winnipeg, Manitoba, R3T 2N2, Canada.
J Hand Microsurg. 2024 Apr 17;16(4):100062. doi: 10.1016/j.jham.2024.100062. eCollection 2024 Oct.
Literature on pediatric flexor tendon repairs remains sparse. Given the various repair techniques and rehabilitation protocols available, the aim of this systematic review is to investigate outcomes of primary pediatric flexor tendon repairs.
MEDLINE, Embase, PubMed, and Cochrane Central Register of Controlled Trials databases were searched from inception to June 2022 in concordance with PRISMA guidelines. Studies were included if patients were under the age of 18, sustained a flexor tendon injury repaired primarily, and had documented functional outcomes. Quality assessment was completed using the Newcastle-Ottawa Scale. The study was registered with PROSPERO (CRD42018089089).
This study includes 20 articles representing 577 patients with 748 injured digits, most frequently injured by a laceration from glass. The number of tendon injuries in zones I, II, III, IV, and V were 78, 431, 62, 2, and 19, respectively. In total, 594 FDP, 374 FDS, and 77 FPL tendons were lacerated. Concurrent digital nerve injuries occurred in 251 digits. Time of repair was 15 h-187 days post-injury, most commonly via the modified Kessler (n = 266 digits) and Kessler (n = 162 digits). Post-operatively, 170 patients were immobilized and 261 patients underwent early active (n = 96) or passive (n = 165) protocols. Functional outcomes were reported in 466 digits (excellent = 306, good = 132, fair = 19, and poor = 9, per the respective assessment tool used). There were 15 tendon ruptures.
Despite heterogeneity in both operative and post-operative protocols, there is low level evidence that low complication rates and good outcomes are expected following primary repair of pediatric flexor tendons.
关于小儿屈指肌腱修复的文献仍然稀少。鉴于现有的各种修复技术和康复方案，本系统评价的目的是研究小儿原发性屈指肌腱修复的结果。
按照PRISMA指南，检索了MEDLINE、Embase、PubMed和Cochrane对照试验中央注册库数据库，检索时间从数据库建立至2022年6月。纳入的研究要求患者年龄在18岁以下，主要接受屈指肌腱损伤修复，并有记录的功能结果。使用纽卡斯尔-渥太华量表完成质量评估。该研究已在PROSPERO（CRD42018089089）注册。
本研究纳入20篇文章，共577例患者，748根手指受伤，最常见的受伤原因是玻璃划伤。I区、II区、III区、IV区和V区的肌腱损伤数量分别为78根、431根、62根、2根和19根。总共594根指深屈肌腱（FDP）、374根指浅屈肌腱（FDS）和77根拇长屈肌腱（FPL）被切断。251根手指同时发生指神经损伤。修复时间为伤后15小时至187天，最常用的修复方法是改良Kessler法（n = 266根手指）和Kessler法（n = 162根手指）。术后，170例患者进行了固定，261例患者接受了早期主动（n = 96）或被动（n = 165）方案。466根手指报告了功能结果（根据各自使用的评估工具，优秀 = 306，良好 = 132，中等 = 19，差 = 9）。有15例肌腱断裂。
尽管手术和术后方案存在异质性，但有低质量证据表明，小儿屈指肌腱一期修复后并发症发生率低且预后良好。
