Chevalley Sara, Wängberg Victoria, Åhlén Martina, Strömberg Joakim, Björkman Anders
Department of Hand Surgery, Sahlgrenska University Hospital, Mölndal, Sweden; Department of Hand Surgery, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
Department of Hand Surgery, Sahlgrenska University Hospital, Mölndal, Sweden; Department of Hand Surgery, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
J Hand Surg Am. 2024 Dec;49(12):1165-1172. doi: 10.1016/j.jhsa.2024.08.011. Epub 2024 Oct 5.
There is no consensus on the optimal postoperative rehabilitation program following flexor tendon repair. Some studies suggest a faster recovery after active mobilization, whereas other studies have failed to find any differences between active and passive mobilization at 12 months. To our knowledge, no prior randomized controlled trial has compared the long-term effects of these two approaches. This randomized controlled trial compared the long-term outcomes of active mobilization with those of passive mobilization in combination with place-and-hold.
Sixty-four patients with a flexor tendon injury in zones I or II were included in the study. After surgery, patients were randomized to either active mobilization or passive mobilization with place-and-hold. Forty-seven patients were available for the 5-year minimum follow-up. Assessments included range of motion, grip strength, key pinch, as well as the Disabilities of the Arm, Shoulder, and Hand (DASH) and ABILHAND questionnaires.
At the 5-year minimum follow-up, range of motion was significantly better in the group treated with passive mobilization with place-and-hold compared with the active mobilization group. Furthermore, there was a significant deterioration in the range of motion and an increased flexion contracture in the active mobilization group compared with 1 year after surgery. Grip strength deteriorated significantly in both groups from the 1-year to the 5-year minimum follow-up, but key pinch did not change. In both groups, DASH and ABILHAND scores improved from the 1-year to the 5-year minimum follow-up.
Passive mobilization with place-and-hold following flexor tendon repair results in superior long-term outcomes compared with active mobilization.
TYPE OF STUDY/LEVEL OF EVIDENCE: Therapeutic I.
对于屈指肌腱修复术后的最佳康复方案，目前尚无共识。一些研究表明主动活动后恢复更快，而另一些研究未能发现主动活动和被动活动在12个月时存在任何差异。据我们所知，此前尚无随机对照试验比较这两种方法的长期效果。本随机对照试验比较了主动活动与被动活动结合定位保持的长期效果。
64例I区或II区屈指肌腱损伤患者纳入本研究。术后，患者被随机分为主动活动组或被动活动结合定位保持组。47例患者完成了至少5年的随访。评估包括关节活动范围、握力、捏力，以及上肢、肩部和手部功能障碍（DASH）和ABILHAND问卷。
在至少5年的随访中，被动活动结合定位保持组的关节活动范围明显优于主动活动组。此外，与术后1年相比，主动活动组的关节活动范围明显恶化，屈曲挛缩增加。从术后1年到至少5年的随访，两组的握力均显著下降，但捏力没有变化。两组的DASH和ABILHAND评分从术后1年到至少5年的随访均有所改善。
与主动活动相比，屈指肌腱修复术后被动活动结合定位保持可带来更好的长期效果。
研究类型/证据水平：治疗性I级。
