Improving Outcomes in Tendon Repair: A Critical Look at the Evidence for Flexor Tendon Repair and Rehabilitation
Improving Outcomes in Tendon Repair: A Critical Look at the Evidence for Flexor Tendon Repair and Rehabilitation
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DOI：
10.1097/prs.0000000000002769
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发表时间：
2016-12-01
影响因子：
3.6
通讯作者：
Wong, Jason K. F.
中科院分区：
文献类型：
--
作者：
Khor, Wee S.;Langer, Martin F.;Wong, Jason K. F.
学习目标：在阅读本文后，学员应该能够：1.了解屈肌腱管理的变化和演变；2.知道如何评估出现屈肌腱断裂的患者。3.了解修复屈肌腱撕裂伤的生物学原理。4.了解屈肌腱修复中与不同区域相关的技术挑战。5.了解术后手部治疗的基本原理。6.概述二次肌腱手术的类型。背景：屈肌腱损伤对手部外科医生构成了相当大的创伤工作量，大量研究致力于改善肌腱修复的结果。这篇继续医学教育文章旨在为手部屈肌腱手术提供一个最新的循证大纲。方法：作者回顾了屈肌腱修复的文献，包括实验和临床研究的平衡概述。对于每个部分，在过去研究的背景下评估最好的证据水平，以提供关于最佳处理的综合意见。结果：该综述强调了屈肌腱手术、临床评估、麻醉技术、手术入路、修复技术和康复方面的当前趋势。精心挑选的插图、数字、表格和视频被用来补充审查的结果。结论：早期主动动员仍然是唯一被证实的改善结果的长期策略。术中结合“大清醒”手术可以进一步改善肌腱的疗效。良好的手术方法、细致的手术、最新的理疗方案和患者教育仍然是获得最佳结果的基石。
Learning Objectives: After reading this article, the participant should be able to: 1. Appreciate the variation and evolution of flexor tendon management 2. Know how to assess the patient who presents with a flexor tendon laceration. 3. Understand the biology of repairing flexor tendon lacerations. 4. Appreciate the technical challenges in flexor tendon repair relating to different zones. 5. Understand the rationale of postoperative hand therapy. 6. Have an overview of the types of secondary tendon surgery.Background: Flexor tendon injury constitutes a considerable trauma workload for hand surgeons, and a vast amount of research is dedicated toward improving outcomes in tendon repair. This Continuing Medical Education article aims to provide an up-to-date evidence-based outline of flexor tendon surgery in the hand.Methods: The authors reviewed the literature on flexor tendon repairs to include a balanced overview of the experimental and clinical research. For each section, the best levels of evidence were assessed in the context of past research to provide a comprehensive opinion on best management.Results: The review highlights current trends in flexor tendon surgery, clinical assessment, anesthetic technique, surgical approach, repair technique, and rehabilitation. Carefully selected illustrations, figures, tables, and video have been used to supplement the findings of the review.Conclusions: Early active mobilization remains the only long-term proven strategy to improve outcomes. Incorporating intraoperative mobilization using "wide-awake" surgery could emerge to further improve tendon outcomes. Good surgical approach, meticulous surgery, up-to-date physiotherapy regimens, and patient education remain the cornerstone of obtaining best outcomes.