屈指肌腱术后早期活动与康复

Early mobilization and rehabilitation after flexor tendon repair

目的 探讨屈指肌腱修复术后早期功能锻炼的方法与意义。方法 对 116例 (2 86指 )无合并骨折的屈指肌腱断裂给予修复 ,术后 3日起开始被动屈曲并辅以主动伸指练习 ,幅度循序渐进 ,4周后开始非辅助性训练 ,并依次给予音频、超短波及蜡疗等理疗 ;出院后每周随访 1次 ,继续指导患者功能锻炼。结果 随访 97例 (2 49指 ) ,时间 6～ 18个月 ,采用TAM评定患指功能 ,优 192指(77 1% ) ,良 2 5指 (10 0 % ) ,可 15指 (6 0 % ) ,差 17指 (6 8% )。结论 腱周粘连在肌腱修复过程中不可避免 ,早期活动促进形成非限制性粘连 ,增加修复腱在腱鞘内滑动度 ,早期恢复腱强度 ;早期活动宜从术后第

Objective To investigate the methods and significance of early mobilization to the function restoration after flexor tendon repair. Methods 286 complete flexor tendon amputation not combined with fractures in 116 cases were repaired. From the third day after operation, the digits were mobilized with a combination of assisted passive flexion and active extension simultaneously for the first 4 weeks. The scope of flexing and extending digits was increased gradually controlled by doctors. Unassisted active flexion extension exercises began 4 weeks postoperatively. The mean active proximal and distal interphalangeal range of motion one week postoperatively was 5°～10° and 10°～20° respectively, 4 weeks postoperatively 40°～50° and 50°～70°. The injured fingers were given physical therapy of voice band therapy 4 weeks postoperatively, supershortwave treatment 4 weeks and wax\|hot therapy 6 weeks postoperatively. Patients were followed up once weekly to be instructed how to go on functional training after they were discharged. Results 97 patients (249 fingers) were followed up from 6 to 18 months. The function recovery of the corresponding fingers was evaluated by TAM method which included excellent 192 digits(77 1%), fine 25 digits(10 0%), approval 15 digits(6 0%) and bad 17 digits(6 8%). Conclusion It is inevitable for the repaired tendon to be adhered to the around tissue. Early mobilization of relevant injured fingers can enhance formation of non limited adhesion, increase excursion of the reconditioned tendon and revert tendon intensity at early time. Early mobilization should begin 3 days postoperatively.