PDF(Pubmed)
Abstract：
BACKGROUND: The primary aim of this study was to present patient-reported functional outcomes after zone 1 and 2 flexor tendon repair using a novel longitudinal volar approach crossing the distal interphalangeal joint (DIPJ) perpendicularly. The secondary aims were to investigate the cosmetic outcomes, satisfaction and complication rates associated with this technique.
METHODS: Over a 6-year period, 75 patients underwent flexor tendon repair using this technique. The quick version of the Disabilities of the Arm, Shoulder and Hand (QuickDASH), five-level EQ-5D (EQ-5D-5L), Patient and Observer Scar Assessment Scale (POSAS) and satisfaction questionnaires were collected. QuickDASH scores were available for 59 patients (79%), and POSAS scores were available for 45 patients (60%) at a mean follow-up of 48 months. Concomitant nerve repairs were undertaken in 24 cases.
RESULTS: The median QuickDASH score was 4.5 (interquartile range [IQR] 1.1-12.5) and median POSAS score was 12 (IQR 8-16). No significant difference was observed in median QuickDASH score between patients with and without a concomitant nerve repair (4.5 vs 6.8; p = 0.36). Fifty-six patients (94%) were satisfied. Two patients required open tenolysis, and a single case of early re-rupture occurred that required revision open repair.
CONCLUSIONS: Utilising validated patient-reported functional outcomes, this study demonstrated that a direct longitudinal incision over the DIPJ for zone 1 and 2 flexor tendon repairs can result in excellent functional and cosmetic outcomes, with high rates of patient satisfaction and low rates of complications. This challenges previously held dogma that longitudinal incisions crossing flexion creases should be avoided.
METHODS: Over a 6-year period, 75 patients underwent flexor tendon repair using this technique. The quick version of the Disabilities of the Arm, Shoulder and Hand (QuickDASH), five-level EQ-5D (EQ-5D-5L), Patient and Observer Scar Assessment Scale (POSAS) and satisfaction questionnaires were collected. QuickDASH scores were available for 59 patients (79%), and POSAS scores were available for 45 patients (60%) at a mean follow-up of 48 months. Concomitant nerve repairs were undertaken in 24 cases.
RESULTS: The median QuickDASH score was 4.5 (interquartile range [IQR] 1.1-12.5) and median POSAS score was 12 (IQR 8-16). No significant difference was observed in median QuickDASH score between patients with and without a concomitant nerve repair (4.5 vs 6.8; p = 0.36). Fifty-six patients (94%) were satisfied. Two patients required open tenolysis, and a single case of early re-rupture occurred that required revision open repair.
CONCLUSIONS: Utilising validated patient-reported functional outcomes, this study demonstrated that a direct longitudinal incision over the DIPJ for zone 1 and 2 flexor tendon repairs can result in excellent functional and cosmetic outcomes, with high rates of patient satisfaction and low rates of complications. This challenges previously held dogma that longitudinal incisions crossing flexion creases should be avoided.
摘要：
背景：本研究的主要目的是介绍患者报告的1区和2区屈肌腱修复后的功能结果，该方法使用一种新型的纵向掌侧方法垂直穿过远端指间关节（DIPJ）。次要目的是调查美容结果，与此技术相关的满意度和并发症发生率。
方法：在6年的时间里，75例患者使用此技术进行了屈肌腱修复。手臂残疾的快速版本，肩和手（QuickDASH），五级EQ-5D(EQ-5D-5L),收集患者和观察者疤痕评估量表（POSAS）和满意度问卷。59名患者（79%）获得了QuickDASH评分，在平均48个月的随访中,45例患者(60%)的POSAS评分均可获得.24例进行伴随神经修复。
结果：QuickDASH评分中位数为4.5（四分位距[IQR]1.1-12.5），POSAS评分中位数为12（IQR8-16）。在有和没有伴随神经修复的患者之间，QuickDASH评分中位数没有显着差异（4.5vs6.8；p=0.36）。56名患者（94%）感到满意。两名患者需要开放性肌腱松解术，和一例早期再破裂发生，需要翻修开放修复。
结论：利用经过验证的患者报告的功能结果，这项研究表明，在DIPJ上进行1区和2区屈肌腱修复的直接纵向切口可以产生出色的功能和美容效果，患者满意度高，并发症发生率低。这种挑战以前一直是教条，即应该避免穿过屈曲折痕的纵向切口。
方法：在6年的时间里，75例患者使用此技术进行了屈肌腱修复。手臂残疾的快速版本，肩和手（QuickDASH），五级EQ-5D(EQ-5D-5L),收集患者和观察者疤痕评估量表（POSAS）和满意度问卷。59名患者（79%）获得了QuickDASH评分，在平均48个月的随访中,45例患者(60%)的POSAS评分均可获得.24例进行伴随神经修复。
结果：QuickDASH评分中位数为4.5（四分位距[IQR]1.1-12.5），POSAS评分中位数为12（IQR8-16）。在有和没有伴随神经修复的患者之间，QuickDASH评分中位数没有显着差异（4.5vs6.8；p=0.36）。56名患者（94%）感到满意。两名患者需要开放性肌腱松解术，和一例早期再破裂发生，需要翻修开放修复。
结论：利用经过验证的患者报告的功能结果，这项研究表明，在DIPJ上进行1区和2区屈肌腱修复的直接纵向切口可以产生出色的功能和美容效果，患者满意度高，并发症发生率低。这种挑战以前一直是教条，即应该避免穿过屈曲折痕的纵向切口。
