Panchal J, Mehdi S, O'Donoghue J M, O'Sullivan S T, O'Shaughnessy M, O'Connor T P
Department of Plastic Surgery, Cork University Hospital, Ireland.
Br J Plast Surg. 1997 Oct;50(7):517-22. doi: 10.1016/s0007-1226(97)91300-x.
A number of early postoperative mobilisation regimes have been developed in an attempt to increase tendon excursion and gliding and thereby reduce formation of adhesions following repair of flexor tendons. Early active flexion mobilisation regimes are becoming more popular, and have replaced early passive flexion regimes in many centres. The aim of the present study was: (a) to determine the range of excursion of flexor tendons in Zone V, and (b) to compare the excursion ranges between active (Belfast) and passive (modified Duran) flexion mobilisation regimes postoperatively. This was done (a) in two cadavers, and (b) in two patients intraoperatively, and postoperatively at 10 days, 3 weeks and 6 weeks. With passive flexion, the mean tendon excursion in Zone V in cadavers was 1 mm for flexor digitorum superficialis (FDS), flexor digitorum profundus (FDP) and flexor pollicis longus (FPL) tendons respectively. With simulated active flexion, the mean tendon excursion was 14 mm, 10 mm and 11 mm respectively. The mean tendon excursion in clinical cases intraoperatively following passive flexion was 2 mm for FDS, FDP and FPL respectively; following simulated active flexion it was 10 mm, 11 mm and 11 mm for FDS, FDP and FPL respectively. On the tenth day following repair, the mean excursions of FDS, FDP and FPL were 1 mm, 4 mm and 4 mm on passive flexion as compared to 3 mm, 10 mm and 12 mm on active flexion respectively. Three weeks postoperatively, the mean excursions of FDS, FDP and FPL tendons were 1 mm, 2 mm and 1 mm on passive flexion as compared to 5 mm, 15 mm on active flexion respectively. Six weeks postoperatively, the mean excursions of FDS, FDP and FPL tendons were 9 mm, 7 mm and 4 mm on passive flexion as compared to 12 mm, 33 mm and 20 mm on active flexion respectively. These results demonstrate an increased excursion of repaired flexor tendons in Zone V following an active flexion mobilisation regime as compared to a passive flexion mobilisation regime.
为了增加肌腱的移动和滑动，从而减少屈指肌腱修复术后粘连的形成，人们制定了多种早期术后活动方案。早期主动屈曲活动方案越来越受欢迎，在许多中心已取代了早期被动屈曲方案。本研究的目的是：(a)确定V区屈指肌腱的移动范围，(b)比较术后主动（贝尔法斯特）和被动（改良杜兰）屈曲活动方案的移动范围。这一研究通过以下方式进行：(a)在两具尸体上，(b)在两名患者术中以及术后第10天、3周和6周进行。被动屈曲时，尸体V区指浅屈肌（FDS）、指深屈肌（FDP）和拇长屈肌（FPL）肌腱的平均肌腱移动分别为1毫米。模拟主动屈曲时，平均肌腱移动分别为14毫米、10毫米和11毫米。临床病例中，被动屈曲后术中FDS、FDP和FPL的平均肌腱移动分别为2毫米；模拟主动屈曲后，FDS、FDP和FPL分别为10毫米、11毫米和11毫米。修复后第10天，被动屈曲时FDS、FDP和FPL的平均移动分别为1毫米、4毫米和4毫米，而主动屈曲时分别为3毫米、10毫米和12毫米。术后3周，被动屈曲时FDS、FDP和FPL肌腱的平均移动分别为小1毫米、2毫米和1毫米，主动屈曲时分别为5毫米、15毫米。术后6周，被动屈曲时FDS、FDP和FPL肌腱的平均移动分别为9毫米、7毫米和4毫米，主动屈曲时分别为12毫米、33毫米和20毫米。这些结果表明，与被动屈曲活动方案相比，主动屈曲活动方案后V区修复的屈指肌腱移动增加。
