Email Alerts
RSS
Volume 40 Issue 4
Apr.  2024
Turn off MathJax
Article Contents
Article Navigation >  CHINESE JOURNAL OF BURNS AND WOUNDS  > 2024  >  40(4): 365-372
Zhu C,He L,He T,et al.Clinical effects of early rehabilitation treatment after repair surgery of skin and soft tissue defects accompanied by extensor tendon injury on the back of hand[J].Chin J Burns Wounds,2024,40(4):365-372.DOI: 10.3760/cma.j.cn501225-20230820-00057.
Citation: Zhu C,He L,He T,et al.Clinical effects of early rehabilitation treatment after repair surgery of skin and soft tissue defects accompanied by extensor tendon injury on the back of hand[J].Chin J Burns Wounds,2024,40(4):365-372.DOI: 10.3760/cma.j.cn501225-20230820-00057.
shu

Clinical effects of early rehabilitation treatment after repair surgery of skin and soft tissue defects accompanied by extensor tendon injury on the back of hand

doi: 10.3760/cma.j.cn501225-20230820-00057
  • 1.

    Department of Burns and Cutaneous Surgery, Burn Center of PLA, the First Affiliated Hospital, Air Force Medical University, Xi'an 710032, China

  • 2.

    Department of Plastic, AestheticMaxillofacial Surgery, the First Affiliated Hospital of Xi'an Jiaotong University, Xi'an 710061, China

  • 3.

    Department of Statistics, Air Force Medical University, Xi'an 710032, China

Funds:

Shaanxi Provincial Key Research and Development Plan 2023-YBSF-179

General Program of National Natural Science Foundation of China 82172208

More Information
    Abstract
  •   Objective   To explore the clinical effects of early rehabilitation treatment after repair surgery of skin and soft tissue defects accompanied by extensor tendon injury on the back of hand.   Methods   This study was a retrospective non-randomized controlled study. From February 2015 to February 2023, 24 patients (15 males and 9 females, aged 12-55 years) with skin and soft tissue defects accompanied by extensor tendon injury on the back of hand, who met the inclusion criteria and were repaired with flap transplantation and tendon grafting or tendon anastomosis, were admitted to the First Affiliated Hospital of Air Force Medical University. According to different intervention time for postoperative rehabilitation treatment of patients, the patients were divided into conventional rehabilitation group and early rehabilitation group, with 12 cases in each group. Patients in early rehabilitation group received rehabilitation treatment immediately after surgery under the rehabilitation guidance of specialized rehabilitation physicians based on the characteristics of different postoperative periods. Patients in conventional rehabilitation group began rehabilitation treatment from the third week after surgery, and their rehabilitation treatment was the same as that of patients in early rehabilitation group from the second week after surgery. The patients in 2 groups were treated in the hospital until the sixth week after surgery. The occurrence of flap vascular crisis and tendon rupture were observed within 6 weeks after surgery. After 6 weeks of surgery, the manual muscle test was used to measure the pinching force between the index finger and thumb, lateral pinching force, three-point pinching force, and grip force of the affected hand; the total action motion method was used to evaluate the finger joint range of motion of the affected hand, and the excellent and good ratio was calculated; the Carroll upper extremity function test was used to score and rate the function of the affected hand.   Results   Within 6 weeks after surgery, only 1 patient in conventional rehabilitation group suffered from venous crisis, and the flap survived after the second surgical exploration and anastomosis of blood vessels; there was no occurrence of tendon rupture in patients of 2 groups. After 6 weeks of surgery, there were no statistically significant differences in pinching force between the index finger and thumb, lateral pinching force, three-point pinching force, or grip force of the affected hand between the two groups of patients ( P>0.05); the excellent and good ratio of the finger joint range of motion of the affected hand of patients in early rehabilitation group was 11/12, which was higher than 7/12 in conventional rehabilitation group, but there was no statistically significant difference ( P>0.05); the affected hand function score of patients in early rehabilitation group was 90±6, which was significantly higher than 83±8 in conventional rehabilitation group ( t=2.41, P<0.05); the function rating of the affected hand of patients in early rehabilitation group was obviously better than that in conventional rehabilitation group ( Z=2.04, P<0.05).   Conclusions   Early rehabilitation treatment for patients with skin and soft tissue defects accompanied by extensor tendon injury on the back of hand after repair surgery can improve hand function, but it would not increase surgery related complications, which is worthy of clinical promotion and application.

     

    • FullText(HTML)
  • loading
    • References(35)
  • [1]
    HarrisonLM,AndersonSR,WimalawansaSM.Outcome of early motion protocol for total hand replantation: 1- and 2-year postoperative results[J].J Hand Microsurg,2020,12(Suppl 1):S70-S74.DOI: 10.1055/s-0039-1697060.
    [2]
    MessanaF, FaccioD, RizzatoS,et al.Combining traditional and microsurgical reconstruction after a complex hand trauma with multiple tissue defects. A case report[J].Ann Ital Chir, 2021,10:S2239253X21035581.
    [3]
    OzbaydarM,OrmanO,OzelO,et al.Multiple extensor tendons reconstruction with hamstring tendon grafts and flap coverage for severe dorsal hand injuries[J].Hand Surg Rehabil,2017,36(6):410-415.DOI: 10.1016/j.hansur.2017.07.004.
    [4]
    赵萍,蒋尚良,陈翔,等.手部肌腱粘连的机制及防治策略[J].实用手外科杂志,2022,36(4):527-531,538.DOI: 10.3969/j.issn.1671-2722.2022.04.030.
    [5]
    GraaP,LöwS,UnglaubF,et al.Treatment of extensor tendon injuries of the hand[J].Orthopadie (Heidelb),2023,52(5):417-431.DOI: 10.1007/s00132-023-04379-1.
    [6]
    AddosookiA,SaidE,KenaweyM,et al.Reconstruction of complex hand defects using trapezoidal osteocutaneous free fibular flap[J].Microsurgery,2020,40(3):306-314.DOI: 10.1002/micr.30520.
    [7]
    庄加川,李敏姣,曾锦浩,等.单根肌腱缝线埋线修复肌腱损伤的临床应用[J].中华手外科杂志,2020,36(4):300-301.DOI: 10.3760/cma.j.cn311653-20200113-00010.
    [8]
    胡大海,易南,朱雄翔.实用烧伤康复治疗学[M].北京:人民卫生出版社, 2016.
    [9]
    贾鑫玮,王辉,王红涛,等.手外伤术后握力及捏力的影响因素的研究进展[J].中国医药导报,2023,20(13):67-70.DOI: 10.20047/j.issn1673-7210.2023.13.15.
    [10]
    朱婵,何林,张博文,等.儿童手烧伤后瘢痕挛缩家庭康复治疗模式的探索[J].中华烧伤与创面修复杂志,2023,39(1):45-52.DOI: 10.3760/cma.j.cn501225-20220622-00253.
    [11]
    赵海洋,韩军涛,刘佳琦,等.手持续被动运动系统联合功能训练与压力手套治疗手背部烧伤后早期瘢痕挛缩的效果[J].中华烧伤杂志,2021,37(4):319-326.DOI: 10.3760/cma.j.cn501120-20201020-00443.
    [12]
    ProcterF. Rehabilitation of the burn patient[J]. Indian J Plast Surg, 2010,43(Suppl): S101-113. DOI: 10.4103/0970-0358.70730.
    [13]
    郑云,田林,崔留超,等.手部损伤功能重建应用异体肌腱的长期随访结果与评估[J].中华手外科杂志,2022,38(6):537-539.DOI: 10.3760/cma.j.cn311653-20220407-00091.
    [14]
    SirousS,TilkornD,HauserJ.Extensor tendon injuries of the hand[J].Chirurg,2020,91(12):1083-1092.DOI: 10.1007/s00104-020-01291-8.
    [15]
    谢勇,詹友达,李洪兵,等.掌背动脉远侧皮支皮瓣修复手指软组织缺损的体会[J].中华手外科杂志,2014,30(1):76.DOI: 10.3760/cma.j.issn.1005-054X.2014.01.030.
    [16]
    LaiYH,LeeYC.Functional chimeric double-barrel fibula and reinnervated peroneus brevis osteomyocutaneous flap for one-stage forearm reconstruction[J].Plast Reconstr Surg Glob Open,2023,11(8):e5182.DOI: 10.1097/GOX.0000000000005182.
    [17]
    XuL,LiuZ,LiuS,et al.Repair of compound dorsal defects of the digits using a free antegrade palmaris longus tendocutaneous venous flap[J].J Hand Surg Am,2023,48(5):510.e1-510.e5.DOI: 10.1016/j.jhsa.2021.11.023.
    [18]
    ChuT, XiaoJ, ZhouX, et al. Free chimeric superficial circumflex iliac artery perforator flap in reconstructing the distal complex extensor tendon injury[J]. Plast Reconstr Surg, 2024, 153(2):442e-447e. DOI: 10.1097/PRS.0000000000010599.
    [19]
    苏日宝,安洪宾,王秀会,等.第一跖背动脉皮瓣串联𧿹趾腓侧皮瓣移植修复手部贯通伤[J].中国修复重建外科杂志,2014,28(12):1567-1568.DOI: 10.7507/1002-1892.20140339.
    [20]
    厉智威,施毓.加速康复外科理念在肝脏外科专科医生培养中的应用[J].中华医学教育探索杂志,2023,22(7):1079-1083.DOI: 10.3760/cma.j.cn116021-20210711-01359.
    [21]
    BűhlerM,Gwynne-JonesD,ChinM,et al.Are the outcomes of relative motion extension orthoses non-inferior and cost-effective compared with dynamic extension orthoses for management of zones V-VI finger extensor tendon repairs: a randomized controlled trial[J].J Hand Ther,2023,36(2):363-377.DOI: 10.1016/j.jht.2023.02.010.
    [22]
    杨占宇,朱海波,王旼娴.动力型支具防治手指屈肌腱松解术后肌腱粘连的临床研究[J].中华手外科杂志,2020,36(4):298-299.DOI: 10.3760/cma.j.cn311653-20190928-00273.
    [23]
    张国强 早期程序化功能锻炼预防屈指肌腱断裂术后粘连的临床观察 济南 山东大学 2019 DOI: 10.7666/d.Y3571929

    张国强. 早期程序化功能锻炼预防屈指肌腱断裂术后粘连的临床观察[D].济南:山东大学,2019. DOI:10.7666/d.Y3571929.
    [24]
    陈靖,王洋,谭军.完全连续锁边水平褥式缝合结合早期主动活动治疗伸肌腱损伤的疗效[J].中华手外科杂志,2019,35(4):307-309.DOI: 10.3760/cma.j.issn.1005-054X.2019.04.027.
    [25]
    ShawAV,VermaY,TuckerS,et al.Relative motion orthoses for early active motion after finger extensor and flexor tendon repairs: a systematic review[J].J Hand Ther,2023,36(2):332-346.DOI: 10.1016/j.jht.2023.02.011.
    [26]
    LuG,SunX,CaoJ,et al.An analysis of the clinical efficacy of early dynamic orthosis after finger extensor digitorum rupture[J].Int J Clin Pract,2022,2022:1267747.DOI: 10.1155/2022/1267747.
    [27]
    周海涛.肌腱损伤的修复与早期康复治疗[J/CD].临床医药文献电子杂志,2018,5(15):87.DOI: 10.3877/j.issn.2095-8242.2018.15.069.
    [28]
    范莹,陈杨.15例带趾伸肌腱及皮神经足背游离皮瓣修复手背患者的护理[J].天津护理,2018,26(4):443-444.DOI: 10.3969/j.issn.1006-9143.2018.04.023.
    [29]
    GuptaA,MirzaeeF,Farahanchi BaradaranA,et al.Biomechanical study of the abductor pollicis longus & extensor pollicis brevis after release and reconstruction of the first dorsal compartment of the wrist[J].Ann Med Surg (Lond),2021,70:102863.DOI: 10.1016/j.amsu.2021.102863.
    [30]
    周瑞明, 管义红, 王全兵, 等. 手部陈旧性伸肌腱损伤修复术后早期介入康复治疗对改善手功能的疗效观察[J]. 中国康复, 2017,32(4):305. DOI: 10.3870/zgkf.2017.04.028.
    [31]
    CollocottS,KellyE,FosterM,et al.A randomized clinical trial comparing early active motion programs: earlier hand function, TAM, and orthotic satisfaction with a relative motion extension program for zones V and VI extensor tendon repairs[J].J Hand Ther,2020,33(1):13-24.DOI: 10.1016/j.jht.2018.10.003.
    [32]
    TunaZ,OskayD,GökkurtA,et al.Does earlier splint removal truly affect functional recovery and kinesiophobia after tendon repair?[J].Hand Surg Rehabil,2020,39(4):310-315.DOI: 10.1016/j.hansur.2020.01.006.
    [33]
    宋君,付瑞玲,任志勇,等. 改良缝合联合早期功能锻炼治疗手指屈肌腱断裂[J]. 实用手外科杂志,2017,31(3):338-340. DOI: 10.3969/j.issn.1671-2722.2017.03.023.
    [34]
    周建东,许亚军,糜菁熠,等. Silfverskiøld缝合法结合术后早期动态伸直治疗Ⅲ、Ⅳ区指伸肌腱损伤[J]. 中华手外科杂志,2016,32(1):28-30. DOI: 10.3760/cma.j.issn.1005-054X.2016.01.015.
    [35]
    MerrittWH, WongAL, LalondeDH. Recent developments are changing extensor tendon management [J]. Plast Reconstr Surg, 2020, 145(3): 617e-628e. DOI: 10.1097/PRS.00000000-00006556.
    • Relative Articles
    • Supplements(0)
    • Cited By
  • 加载中

Catalog

    通讯作者: 陈斌, bchen63@163.com
    • 1. 

      沈阳化工大学材料科学与工程学院 沈阳 110142

    1. 本站搜索
    2. 百度学术搜索
    3. 万方数据库搜索
    4. CNKI搜索

    Figures(3)  / Tables(4)

    Get Citation
    PDF
    XML

    Article Metrics

    Article views (58) PDF downloads(11) Cited by()
    Proportional views
    Related

    Copyright © Chinese Journal of Burns京ICP备07035254号-14

    E-mail：shaoshangzazhi@163.com

    Website：https://zhsszz.xml-journal.net/

    Supported by: Beijing Renhe Information Technology Co. Ltd    

    /

    DownLoad:  Full-Size Img  PowerPoint
    Return
    Return