Review and comparison of current trends in the postoperative management of tendon repair.
Review and comparison of current trends in the postoperative management of tendon repair.
复制标题
肌腱修复术后管理当前趋势的回顾和比较。
作者：
K. M. Stewart
Evans/Burkhalter方案的精确性和Silverman及其同事的工作是当前肌腱愈合康复领域最有价值的趋势之一。了解每个关节在每个水平和整个运动范围内的肌腱偏移，为我们提供了肌腱活动的安全参数。手部康复正在成为一门科学，同时仍然是一门艺术。对肌腱愈合、营养、解剖学、生物力学和生理学的研究为我们的治疗技术提供了坚实的基础。我们现在需要重复已经进行的研究，并更精确地量化我们拥有的数据。许多问题仍未得到解答。在目前的方案下，屈肌腱活动的夹板位置有很多种：哪些关节位置是最佳的，为什么？在早期活动方案中，重复的次数和频率差别很大：什么次数和频率更适合哪些患者？多少肌腱偏移可以控制粘连，促进愈合，避免间隙形成或修复延伸？我们应该被动地施加多大的力来维持或增加关节运动？我们应该多快开始主动运动，我们如何控制那些早期肌肉收缩的力量？“原地保持”练习真的能减轻维修现场的压力吗？我们应该多快开始抵抗运动？每种运动的抵抗强度是多少？阻塞练习应该被认为是抵抗性的吗？在存在相关损伤的情况下，肌腱管理方案应如何调整？由于篇幅有限，本文无法讨论一些领域的最新和需要的研究，如超声、离子导入和神经肌肉电刺激在肌腱治疗中的有效性和适当的预防措施。证据越来越多，但我们还有很长的路要走。为了改善我们的临床结果，向精确的趋势必须继续和发展。
The precision of the Evans/Burkhalter protocol and the work by Silverman and associates exemplify one of the most valuable of all current trends in rehabilitation of the healing tendon. Knowledge of tendon excursion at each level and throughout the range of motion in each joint gives us safe parameters for tendon mobilization. Hand rehabilitation is becoming more of a science while remaining an art. Research into tendon healing, nutrition, anatomy, biomechanics, and physiology gives us a solid basis for our treatment techniques. We now need to replicate studies already performed and quantify more precisely the data we have. Many questions remain unanswered. There is a wide variety in the position of splinting for flexor tendon mobilization under current protocols: What joint positions are optimal and why? The number and frequency of repetitions in early mobilization protocols varies greatly: What number and frequency is more appropriate for which patients? How much tendon excursion will control adhesions, promote healing, and avoid gap formation or elongation of the repair? How much force should we apply passively to maintain or increase joint motion? How soon should we start active motion, and how can we control the strength of those early muscle contractions? Do "place-hold" exercises truly place less tension on the repair site? How soon should we begin resisted exercise, and how much resistance are we applying with each type of exercise? Should blocking exercises be considered resistive? How should tendon management protocols be adapted in the presence of associated injuries? Lack of space has prevented discussion here of recent and needed research in a number of areas, such as the effectiveness and appropriate precautions for the use of ultrasound, iontophoresis, and neuromuscular electrical stimulation in tendon management. The evidence is growing, but we have a long way to go. To improve our clinical results, the trend toward precision must continue and grow.