Observation of the therapeutic effect of dynamic braces for repairing extensor tendon injuries in the hand after surgery
Objective: To explore the treatment methods and efficacy of using dynamic braces combined with early hand function exercise after repairing extensor tendon injuries in the hand. Method: 26 patients with 65 finger extensor tendon injuries (III-VII) after repair surgery were treated with dynamic braces and underwent early planned, guided, and systematic functional exercise. The control group (28 cases and 69 fingers) did not receive programmed rehabilitation treatment in addition to routine clinical treatment in the early stage. As a result of early rehabilitation treatment, the proportion of patients who achieved excellent results and recovered from their original work within 3 months after surgery was significantly increased compared to the control group, as evaluated by the TAM method. Conclusion: The intervention of dynamic rehabilitation braces in treatment provides effective safety guarantees for early activity. Passive movement under postoperative control has gradually replaced the method of complete braking. After the repair of extensor tendon injury in the hand, early and effective functional exercise can prevent adhesion and reduce the incidence of tendon re rupture, avoiding secondary tendon release surgery.
Tag: extensor tendon injury; Power support device; The continuous development of early exercise and hand surgery techniques has made tendon repair techniques more mature. However, due to prolonged immobilization or inadequate functional training after injury, varying degrees of tendon adhesion and loss of hand function may occur. In the rehabilitation treatment of hand extensor tendon injury repair surgery at the hospital where the author is located, a self-designed dynamic rehabilitation brace made of low-temperature thermoplastic sheet is used; Allowing patients to actively flex their fingers early within the control range of the brace, utilizing the elasticity of the steel wire to passively extend their fingers, and applying it clinically has achieved good results.
1. Data and Methods
1.1 General Information: From August 2004 to January 2005, the author's hospital treated 26 cases (65 fingers) of hand extensor tendon (zones III-VII) injuries who underwent early application of dynamic braces for functional exercise under protection after primary tendon repair surgery (rehabilitation group). The fabrication of braces for extensor tendon injuries (I-II) varies; There are few cases of patients with finger bone fractures and combined flexor tendon injuries using this brace, and this article did not evaluate it. Another 28 cases (69 fingers) without formal rehabilitation treatment after previous treatment were selected as the control group. The general situation of the two groups is shown in Table 1. There were no statistically significant differences in gender, age, injury type, injury finger type, and injury site between the two groups (all P>0.05).
1.2 Rehabilitation treatment methods: All extensor tendon injuries are repaired by experienced hand surgeons according to uniform standards [2]. The surgery should be completed within 12 hours after the injury. The rehabilitation group will receive guided, planned, and step-by-step rehabilitation treatment from the second day after surgery.
1.2.1 Low temperature thermoplastic plate (produced by Guangzhou Kolairedi Medical Equipment Co., Ltd.) is selected for the production of the support, and a self-made forearm dorsal dynamic support is used for fixation. Extend the wrist joint at 20 ° -40 ° and the metacarpophalangeal and interphalangeal joints at 0 ° (if there is nerve injury, extend the wrist straight at 0 °); Its length ranges from the middle of the forearm to the metacarpophalangeal joint on the back of the hand. Simultaneously producing a steel wire elastic device for stretching fingers: selecting points in the bottom area of the wrist and metacarpal bones on the dorsal support. To deal with injuries
Table 1 Comparison of General Conditions of Hand Stretching Tendon Injuries between Two Groups (n) Number of Cases, Gender, Gender, Age (Year) Type of Injury Finger (Finger) Location of Injury (Finger) Knife Cut, Glass Cut, Thumb Food Ring Small III IV V VI VII Rehabilitation Group 26 (65) 20615~4519791817129814171610 Control Group 28 (69) 23514~4722691621158711211 Fingers correspond to fixed steel wires with proximal ends. The length of the steel wire is generally curved to the distal end of the finger, and the distal end of the steel wire is bent into a hook to hang a cortical finger sheath, which is vertically placed on the fingertip of the injured finger. Secure the support with Velcro.
1.2.2 Early rehabilitation exercise methods (1) The rehabilitation treatment group started using the brace after 48 hours of wound hemostasis and stability. Under the guidance of a rehabilitation therapist, actively flex the injured finger within the control range of the brace, and passively extend the finger by relying on the elasticity of the steel wire, doing 5-10 times per hour. Increase or decrease the number of activities and degree of flexion according to the reaction; Wear rehabilitation braces throughout the day. (2) Three weeks (22 days) after surgery, the active part was removed and replaced with a wrist extension brace (fixed at 40 ° extension), (if there is nerve injury, the wrist extension is 0 °); Active flexion and extension of fingers; Continue to wear it all day. (3) After 4-6 weeks postoperatively, remove the wrist extension brace during the day and wear it at night; Gentle resistance finger flexion activity. (4) After 7 weeks (50 days) postoperatively, all braces were removed and progressive resistance exercises were initiated to enhance muscle strength. And adopt homework therapy, various strength grip, lifting, holding, pinching training, and finger dexterity and coordination training. After 12 weeks, resume work. Control group: After extensor tendon repair surgery, resin bandages are often used to make palmar plaster casts, fixing the wrist and finger joints in the dorsiflexion position. The plaster casts can be removed after 4-6 weeks before starting exercise activities. Except for routine clinical treatment, no programmed rehabilitation therapy is performed, and the wound is discharged after healing. All patients were followed up and observed for 3-4 months. Functional recovery was evaluated using the TAM method to determine the efficacy criteria; And the number of cases that returned to their original jobs three months after surgery was counted; After statistical analysis, the difference between the two is statistically significant with a value of 7.81 (P<0.05), as shown in Table 2. Table 2 Comparison of follow-up recovery between two groups of patients n (%) Number of cases in each group Excellent, medium poor, excellent rate (%) Recovery of original work P-value Rehabilitation group 2616 (61.5) 8 (30.8) 2 (7.7) 0 (0) 92.323 (88.5)
<0.05 Control group 288 (28.6) 10 (35.7) 5 (17.9) 5 (17.9) 64.315 (53.8) 3 Discussion
3.1 Tendon injuries are extremely common in hand surgery. The extensor tendon structure is flat, thin, wide, and more prone to rupture. The tendon surface of the back of the hand is shallow, with a high rate of injury, and is prone to adhesion with the bone. Changes or adhesions in the length of the extensor tendon can affect the transmission of force, causing obstacles to the opponent's function. In the past, palmar plaster casts were commonly used after extensor tendon repair surgery to fix the wrist and finger joints in the dorsiflexion position. The plaster casts can only be removed after 4-6 weeks before starting exercise activities. Due to the use of braking measures after surgery, it is easy to cause varying degrees of joint adhesion, stiffness, and even contracture, leaving hand dysfunction and affecting work and life. If rehabilitation treatment is not implemented early, the disability rate is high. After clinical observation, the author found that a self-designed power rehabilitation brace made of low-temperature thermoplastic sheet was used for the repair of extensor tendons (zones III-VII). Early use of dynamic braces combined with functional exercise can effectively prevent tendon adhesion and joint stiffness by maintaining joint activity and restoring muscle strength. As shown in Table 2, the excellent and good rate of the rehabilitation group is significantly higher than that of the control group. Early rehabilitation treatment can improve the TAM score of patients and facilitate the recovery of their hand function.
3.2 The currently recognized best method for preventing tendon adhesion is still rehabilitation therapy through early functional exercise. Early rehabilitation treatment is a critical period that determines the success or failure of hand function recovery. The postoperative functional recovery mainly depends on effective and timely functional exercise. Within 24-48 hours after surgery, the main focus should be on immobilization. After 48 hours, excess dressings should be removed and systematic and planned rehabilitation exercises should begin. The use of power supports provides effective safety guarantees for early activities. The power support of the hand combines the active and passive movements of the interphalangeal joints through traction. Early movement can increase tendon tension and sliding distance, promote tendon healing and scar shaping. Swelling subsides quickly, and early functional exercise using rehabilitation braces effectively reduces the incidence of tendon adhesion and re rupture, avoiding secondary tendon release surgery and achieving good social and economic benefits, with an excellent rate of 90%. Passive movement under postoperative control has gradually replaced the method of complete braking.
3.3 In order to achieve good recovery of hand function after tendon injury, precise microsurgical techniques are a prerequisite, and early application of rehabilitation training is an indispensable and important link [3]. Psychological therapy should also be integrated into rehabilitation therapy
The entire process. Explain the importance of postoperative functional exercise to patients, making them understand that surgical success is only half of treatment success, and the other half depends on postoperative functional rehabilitation. Daily examination and guidance are provided to patients, observing the progress of finger movements to enhance their confidence in overcoming the disease and striving for the best therapeutic effect.
The key to early hand control activities lies in the production of hand functional support devices. Low temperature thermoplastic plates as support materials are not only convenient to produce and lightweight to use, but also have a beautiful appearance and precise therapeutic effects. They can be repeatedly processed and modified at any time, are easy to clean, and are convenient to use, which is more superior than support devices made of plaster or resin bandages. It is a necessary tool for early functional exercise after extensor tendon repair surgery.
