Larwa Joseph, Buchanan Timothy R, Janke Rachel L, Burns Madison Q, Wright Logan, Hao Kevin A, Cueto Robert J, Hones Keegan M, Aibinder William R, Wright Thomas W, Schoch Bradley S, King Joseph J
Department of Orthopaedic Surgery and Rehabilitation, University of Florida, Jacksonville, FL, USA.
College of Medicine, University of Florida, Gainesville, FL, USA.
Shoulder Elbow. 2024 Aug 6:17585732241269807. doi: 10.1177/17585732241269807.
As no consensus exists on the optimal postoperative rehabilitation protocol in terrible triad injuries, we sought to characterize the reported protocols and relate them to postoperative range of motion (ROM) measures and Mayo Elbow Performance Score (MEPS).
A systematic review was performed by searching PubMed/MEDLINE, Embase, Web of Science, and Cochrane databases to identify articles on the operative treatment of terrible triad injuries reporting postoperative rehabilitation protocols were included. Included studies were descriptively summarized. Methodologic quality was assessed using the Methodological Index for Non-randomized Studies criteria. Meta-analysis compared postoperative ROM measures and the MEPS between patients initiating passive ROM exercises at ≤7 days vs. >7 days.
Our review included 36 articles with 1123 elbows (66% male, mean age: 43 years, follow-up: 27 months). Of the studies reporting physical therapy protocols, it was most commonly initiated at 7 days postoperatively (6/36, 17%), passive ROM exercises at 7 days (3/25, 12%), and active ROM at 21 days (4/26, 15%). On meta-analysis, early passive ROM initiation was not associated with improved elbow ROM or MEPS.
While rehabilitation protocols commonly advised passive ROM at one week post-operatively, meta-analysis did not support functional benefits of early passive ROM.
Systematic Review; Level of evidence, 4.
由于对于复杂肘关节恐怖三联征损伤术后最佳康复方案尚无共识，我们试图对已报道的方案进行特征描述，并将其与术后活动范围（ROM）测量值及梅奥肘关节功能评分（MEPS）相关联。
通过检索PubMed/MEDLINE、Embase、科学网和Cochrane数据库进行系统评价，以确定有关复杂肘关节恐怖三联征损伤手术治疗并报告术后康复方案的文章。对纳入研究进行描述性总结。采用非随机研究方法学指标标准评估方法学质量。荟萃分析比较了在≤7天与>7天开始进行被动ROM锻炼的患者之间的术后ROM测量值及MEPS。
我们的综述纳入了36篇文章，共1123例肘关节（66%为男性，平均年龄：43岁，随访时间：27个月）。在报告物理治疗方案的研究中，最常见的是术后7天开始（6/36，17%），被动ROM锻炼在7天开始（3/25，12%），主动ROM在21天开始（4/26，15%）。荟萃分析显示，早期开始被动ROM与改善肘关节ROM或MEPS无关。
虽然康复方案通常建议术后1周进行被动ROM，但荟萃分析并不支持早期被动ROM的功能益处。
系统评价；证据级别，4级。
