Pull-out vs. Naht bei Beugesehnenverletzungen der Zone Ia-Ib: klinische Ergebnisse einer multizentrischen Kohortenstudie

Zusammenfassung

Hintergrund Für die Behandlung von Beugesehnenverletzungen der Zone 1a-b sind verschiedene chirurgische Techniken beschrieben. Es ist jedoch kein eindeutiger Goldstandard vorhanden. Ziel dieser multizentrischen Studie war es, die Resultate der Behandlung mit Auszugsnaht- (POS) und Direktnahttechnik (DS) zu vergleichen.

Patienten und Methoden Fünfzehn Patienten wurden von 2014 bis 2020 mit der Auszugstechnik und 22 Patienten mit der direkten Nahttechnik behandelt. Beide Gruppen wurden frühfunktionell nach dem «controlled active motion» (CAM) Schema nachbehandelt und an standardisierten Messzeitpunkten untersucht. Daten zu demografischen, chirurgischen und therapeutischen Merkmalen wurden zu Beginn der Studie sowie in den postoperativen Wochen 6 und 13 erhoben. Der primäre Endpunkt war die Komplikationsrate. Zu den sekundären Endpunkten gehörten die Reoperationsrate, der Bewegungsumfang der Finger (ROM) sowie die Kraft und Patientenzufriedenheit.

Ergebnisse Das Alter betrug in beiden Gruppen zwischen 18 und 75 Jahre. Das Verletzungsmuster war bei allen Patienten eine komplette Durchtrennung der FDP Sehne durch eine Schnittverletzung. Die Komplikationsrate betrug 41% in der POS und 16% in der DS Gruppe. Die Reoperationsrate war 29% in der POS Gruppe und 8% in der DS Gruppe. Statistisch signifikante Unterschiede gab es beim passiven DIP und passiven PIP und DIP Bewegungsumfang in Woche 6 und 13 zugunsten der Direktnahttechnik. Die Kraftmessung in Woche 13 ergab 28.7 (11.6) kg in der POS Gruppe sowie 21.3 (7.9) kg in der DS Gruppe. Dieser Unterschied war statistisch signifikant. Bei den Zufriedenheitswerten zeigte sich kein statistisch signifikanter Unterschied mit 7.5 (2.2) Punkten in der POS und 7.7 (1.3) in der DS Gruppe (p=0.839).

Schlussfolgerung Die Studie zeigt eine tiefere Komplikationsrate mit geringerer Reoperationsrate bei einer Direktnaht im Vergleich zur Auszugsnaht. Obwohl die klinischen Resultate beider Gruppen nach 13 Wochen vergleichbar waren, empfehlen wir zur Vermeidung von Komplikationen und zur frühen aktiven Mobilisation wenn technisch möglich die Direktnahttechnik. Zudem sollten zur Verstärkung der Direktnaht wann immer möglich die benachbarten Strukturen miteinbezogen werden.

Abstract

Background Several surgical techniques have been reported for flexor tendon zone 1a-b lacerations without a clear consensus on the gold standard treatment. The purpose of this multicentre study was to measure the outcomes of zone 1a-b flexor tendon injuries treated with a pull-out suture (POS) versus direct suture (DS) technique.

Patients and Methods Fifteen patients were treated with the pull-out technique and 22 patients with a direct suture technique between 2014 and 2020. The controlled active motion (CAM) regimen protocol and a standardised follow-up schedule were used in both groups. Data on the demographics, surgery, and treatment characteristics were collected at baseline as well as at week 6 and 13 post-operatively. The primary outcome measurement was the complication rate. Secondary outcome measurements were reoperation rate, finger range of motion (ROM), strength as well as patient satisfaction.

Results The patient age ranged from 18 to 75 years in both groups with all patients having a complete FDP lesion after a clean-cut injury. The complication rate was 41% in the POS group and 16% in the DS group. The reoperation rate was 29% in the POS group and 8% in the DS group. Significant between-group differences in favour of the DS group were found in the passive DIP and passive PIP+DIP ROM at week 6 and week 13. Mean hand strength was 28.7 (11.6) kg in the POS group at week 13 and 21.3 (7.9) kg in the DS group. This difference was statistically significant (p=0.012) with a medium effect size (r=-0.41). Average patient satisfaction at week 13 was 7.5 (2.2) points in the POS and 7.7 (1.3) points in the DS group. The difference between groups was not significant (p=0.839).

Conclusion This register-based study demonstrates lower complication and reoperation rates with the direct suture approach compared with a pull-out button technique. Although clinical results were similar between the two surgery techniques at week 13 post-surgery, a direct suture approach should always be attempted whenever possible. If necessary, other local structures should be included to increase suture strength and allow for early active motion rehabilitation regimens.

Key words

FDP tendon zone 1 - pull-out - suture - tendon repair

Schlüsselwörter

FDP-Sehne Zone 1 - Auszugsnaht - Naht - Sehnenreparatur

^* Shared authorship

Publication History

Received: 28 April 2023

Accepted: 14 November 2023

Article published online:
15 February 2024

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