Cook A C, Szabo R M, Birkholz S W, King E F
Kaiser Permenente, Davis, Sacramento, California, USA.
J Hand Surg Br. 1995 Apr;20(2):228-30. doi: 10.1016/s0266-7681(05)80057-9.
A prospective randomized study was undertaken of 50 consecutive patients undergoing surgery for idiopathic carpal tunnel syndrome to determine the value of splintage of the wrist following open carpal tunnel release. Patients were randomized to either be splinted for 2 weeks following surgery or to begin range-of-motion exercises on the first post-operative day. Subjects were evaluated at 2 weeks, 1 month, 3 months, and 6 months after surgery by motor and sensory testing, physical examination, and a questionnaire. Variables assessed included date of return to activities of daily living, dates of return to work at light duty and at full duty, pain level, grip strength, key pinch strength, and occurrence of complications. Patients who were splinted had significant delays in return to activities of daily living, return to work at light and full duty, and in recovery of grip and key pinch strength. Patients with splinted wrists experienced increased pain and scar tenderness in the first month after surgery; otherwise there was no difference between the groups in the incidence of complications. We conclude that splinting the wrist following open release of the flexor retinaculum is largely detrimental, although it may have a role in preventing the rare but significant complications of bowstringing of the tendons or entrapment of the median nerve in scar tissue. We recommend a home physiotherapy programme in which the wrist and fingers are exercised separately to avoid simultaneous finger and wrist flexion, which is the position most prone to cause bowstringing.
对50例因特发性腕管综合征接受手术的连续患者进行了一项前瞻性随机研究，以确定开放性腕管松解术后手腕夹板固定的价值。患者被随机分为术后夹板固定2周或术后第一天开始进行关节活动度练习两组。在术后2周、1个月、3个月和6个月时，通过运动和感觉测试、体格检查及问卷调查对受试者进行评估。评估的变量包括恢复日常生活活动的日期、恢复轻体力工作和全负荷工作的日期、疼痛程度、握力、捏力以及并发症的发生情况。接受夹板固定的患者在恢复日常生活活动、恢复轻体力和全负荷工作以及握力和捏力恢复方面有明显延迟。手腕接受夹板固定的患者在术后第一个月疼痛和瘢痕压痛增加；除此之外，两组并发症发生率无差异。我们得出结论，屈肌支持带开放性松解术后手腕夹板固定在很大程度上是有害的，尽管它可能在预防罕见但严重的肌腱弓弦状畸形或正中神经在瘢痕组织中卡压等并发症方面有一定作用。我们推荐一个家庭物理治疗方案，其中手腕和手指应分开锻炼，以避免手指和手腕同时屈曲，因为这是最容易导致弓弦状畸形的姿势。
