手の骨折手術後の腱剥離術：システマティックレビュー
Bart C J M DE Vries1, Joris A VAN Dongen2, E P A Brigitte VAN DER Heijden1
1Department of Plastic Surgery, Jeroen Bosch Ziekenhuis/Radboudumc, 's-Hertogenbosch/Nijmegen, Netherlands.
Abstract:
Background: Stiffness based on tendon adhesions after operative treatment of hand fractures remains a relevant complication, for which tenolysis may be needed. This systematic review aims to analyse the incidence of tenolysis after surgical hand fracture treatment and related clinical outcomes. Methods: The review was performed according to the PRISMA guidelines. CINAHL, Cochrane Central Register of Controlled Trials/Clinical Answers/Database of Systematic Reviews, Embase, PubMed and Web of Science were searched for articles until 31 December 2024, using keywords. Studies were included in the case of patients aged 16 years or older, who have undergone tenolysis for flexor and/or extensor tendon adhesions after surgical treatment of phalangeal and/or metacarpal fractures. The outcomes were the incidence of tenolysis and total active motion, passive and/or active range of motion (P/AROM) and lag of motion post-tenolysis. The included articles were assessed for methodological quality and risk of bias using the Critical Appraisal Skills Programme checklists, the Joanna Briggs Institute critical appraisal tools and the National Institutes of Health quality assessment tools. Results: Eight out of 160 studies were included. These studies reported an incidence of tenolysis of surgically treated phalangeal fractures varying from 4% to 32%. Only the study of Wong et al. statistically analysed the AROM of the metacarpophalangeal (MCP), proximal interphalangeal (PIP) and distal interphalangeal (DIP) joint pre- to post-tenolysis, showing a significant improvement of the AROM of the PIP joint (p = 0.012). However, based on the quality assessment, the included articles have poor to fair quality. Conclusions: Based on these studies, no definite conclusions concerning the incidence and clinical effect of tenolysis in terms of improvement of MCP-, PIP- and DIP-joint motion can be drawn. Due to the lower quality of these studies, future high-quality research with prospective registration is needed. Level of Evidence: Level IV (Therapeutic).
