动力型支具结合早期康复锻炼在屈指肌腱Ⅱ区修复术后的临床疗效观察

杨家全 陈坤强 周欢斌

[摘要] 目的 觀察动力型支具结合早期功能锻炼在屈指肌腱Ⅱ区断裂修复术后应用对手指功能恢复的临床疗效。 方法 选取我院2017年6月～2018年10月期间屈指肌腱Ⅱ区断裂并行手术修复的47例（共81指）患者，按照来院先后随机分成治疗组（19例，共34指）和对照组（28例，47指）。治疗组肌腱修复术后给予动力型支具固定，并在术后第1天开始在支具保护下行手指主动伸指和被动屈伸手指锻炼，对照组给予静力型支具固定，两组支具均固定在相同的位置。两组患者均支具固定至术后3周，并在术后4周、6周、12周按TAM法评定手指总主动活动度。 结果 通过TAM法评定优良率，结果显示治疗组术后4周、6周、12周TAM优良率均明显优于对照组（P<0.05），这个优势于术后4周、6周更为明显。 结论 动力型支具结合早期功能锻炼在屈指肌腱Ⅱ区断裂术后应用能较早的获得较好的手指主动屈伸活动度，利于屈指肌腱Ⅱ区损伤术后早期康复。

[关键词] 屈肌腱修复;Ⅱ区;动力矫形器;功能恢复

[中图分类号] R473.6          [文献标识码] B          [文章编号] 1673-9701（2020）15-0080-03

Observation of the clinical effect of dynamic orthosis combined with early rehabilitation exercise after zone Ⅱ flexor tendon repair

YANG Jiaquan   CHEN Kunqiang   ZHOU Huanbin   LIAO Jianping

Department of Orthopaedics， Jiujiang First People's Hospital in Jiangxi Province， Jiujiang   332000， China

[Abstract] Objective To observe the clinical effect of dynamic orthosis combined with early function exercise on the recovery of finger function after repair of the flexor tendon zone Ⅱ rupture. Methods A total of 47 patients（81 fingers） who underwent surgical repair of the flexor tendon zone Ⅱrupture in our hospital from June 2017 to October 2018 were randomly divided into treatment group（19 patients， 34 fingers） and control group（28 patients， 47 fingers）. The treatment group was given a dynamic orthosis fixation after tendon repair， and on the first day after surgery， the fingers were actively and passively extended and flexed under the protection of the orthosis. The control group was given static orthosis. Both orthoses were fixed in the same position. Both groups of patients were fixed by orthosis to 3 weeks after operation， and the total active finger activity was evaluated by TAM method at 4 weeks， 6 weeks， and 12 weeks after operation. Results The excellent and good rate was evaluated by TAM method. The results showed that the excellent and good rate of TAM in the treatment group was significantly better than that in the control group at 4 weeks， 6 weeks， and 12 weeks after operation（P<0.05）， and this advantage was more obvious at 4 and 6 weeks after surgery. Conclusion The application of dynamic orthosis combined with early function exercise after the surgery for the flexor tendon zone Ⅱ rupture can obtain better active flexion and extension of the fingers earlier， which is beneficial to early rehabilitation after injury of flexor tendon zone Ⅱ.

在修复肌腱时，本文使用了改良Kessler法加肌腱周围连续锁边缝合法。因为大量的研究表明，此方法的缝合强度足以进行早期主动运动，并减少肌腱粘连、断裂等并发症[11-13]。本研究中47例患者采用此缝合方法，未出现肌腱再断裂病例。

临床上被动锻炼应遵循过程要缓慢、幅度要充分的原则[14]。动力型支具不是无限制的活动，是采用动静结合的方法。因为关节松动技术作用于关节周围纤维组织时，纤维组织被拉长，需达到一定时间后关节周围纤维组织由弹性延长才会转变为塑性延长，所以功能锻炼后仍需结合静态制动，两者协同作用，才能提高疗效、缩短治疗时间[15-17]。……