屈肌腱修复

Patients › Rehabilitation

在手指屈肌腱修复术后，采用早期主动活动康复计划，使用曼彻斯特短夹板从第一周开始轻柔且安全地活动正在愈合的肌腱，同时保护修复部位六周。

示意图显示屈肌腱沿手指掌侧在其腱鞘内走行。 — 屈肌腱负责弯曲手指，它们沿着手掌侧的紧密鞘管走行；断裂的肌腱经修复后，在愈合过程中需仔细保护。 Kieran Hirpara 4.0

本方案旨在指导您在基兰·希尔帕拉（Kieran Hirpara）医生于洛克汉普顿 Mater 私立医院完成手指屈肌腱手术修复后的康复过程。屈肌腱是位于手指掌侧、使手指向掌心弯曲的肌腱。方案首先介绍您的家庭锻炼计划，随后是专为您的手部治疗师制定的结构化临床方案：请在首次治疗时携带此页面或其 PDF 文件，以确保康复过程协调一致。您的手部治疗师可能会根据您的康复进展调整该计划。

如果您对术后伤口有任何疑虑，请与诊所联系。拍摄伤口照片并通过电子邮件发送以供审查通常很有帮助。

预期情况

屈肌腱修复术将断裂的肌腱断端缝合在一起，使手指能够再次弯曲。修复后的肌腱强度足以立即进行轻柔的活动，但在最初的几周内，随着肌腱愈合，其强度处于最低点。因此，整个康复计划围绕“适度活动”展开，旨在保持肌腱滑动，同时避免施加足以导致缝线断裂的负荷。

为此，您的手部将佩戴一种名为曼彻斯特短夹板的特殊轻型夹板进行休息。与旧式笨重的夹板不同，该夹板较短，止于腕横纹处，从而保留手腕的活动空间。它允许您的手腕向前和向后完全活动至约45度，同时一个小阻挡块限制您的掌指关节伸直超过约30度，并允许您的指间关节自由活动。您需要全天候佩戴六周，仅在按指示进行锻炼和清洗时取下。

其精妙之处在于手腕的使用方式。当您向前弯曲手腕时，手指会几乎自动伸直（这称为肌腱固定效应），使您无需肌肉强力驱动即可完全张开手指。当您向后弯曲手腕时，轻柔地卷曲手指会变得更加容易和安全。以这种方式活动可保持肌腱滑动，关键在于防止手指蜷缩成僵硬弯曲的状态，这是此类修复术后最常见的问题。

早期锻炼（从第4–5天开始）轻柔且具体：首先被动弯曲手指，然后从指尖开始进行轻度的主动“钩状”屈曲，最后在手腕弯曲的情况下伸直手指。六周内禁止用力抓握和强制活动。六周后取下夹板，开始轻度力量训练，大多数人在十至十二周后恢复手部的完全 unrestricted（无限制）使用。

注意事项与限制

连续六周全天佩戴曼彻斯特短夹板：仅在进行锻炼和清洗时取下，请遵医嘱。
切勿握紧硬拳，切勿用患手抓握、提举、拉扯或搬运任何物品，持续时间为术后六周：过度负重可能导致修复处断裂。
切勿强行伸直手指或强行弯曲手指；所有动作应轻柔，且仅限于您已掌握的活动范围内。
您可以使用患手进行极轻度的安全任务，但不包括受伤的手指，前提是没有任何动作会牵拉或使其受力。
若出现“啪”的一声或突然的“松弛感”并伴有手指屈曲功能丧失，可能提示肌腱断裂：一旦发生，请立即联系诊室。
佩戴夹板期间切勿驾驶车辆；拆除夹板后（约六周），待握力和控制能力恢复良好并经医生许可后方可恢复驾驶。

关于伤口、肿胀和瘢痕管理，请参阅诊所的伤口护理指南。

您的练习

这些是您讲义中的练习。仅在 Hirpara 医生和您的手部治疗师的指导下开始练习，并严格遵循您被允许的关节活动度和限制。每次练习均遵循相同的安全顺序：首先被动轻柔弯曲手指，然后进行主动的“钩状”屈曲和肌腱滑动练习，接着在屈腕状态下伸直手指，以防止手指僵硬成屈曲状态。所有动作均应轻柔：此为滑动练习，而非力量训练。放置保持（place-and-hold）和阻挡（blocking）练习属于后续阶段，仅在手部治疗师指导您开始后方可进行。若任何动作引起修复部位锐痛，请立即停止；在获得许可前，切勿用力握紧拳头。

您的临床方案

本页面其余部分为使用曼彻斯特短夹板及早期主动活动（EAM）方案进行屈肌腱修复后的分阶段康复临床方案。本节内容将提供给您的手部治疗师，每个阶段均以通俗易懂的语言解释当前正在进行的处理。修复处在最脆弱的早期阶段，此时会承受主动及抗阻性手指屈曲（即用力握拳）带来的负荷；因此，该方案旨在防止强力屈曲，同时刻意促进肌腱滑动及主动指间关节（IP）伸展，以预防作为主要恼人并发症的屈曲挛缩。

治疗前，请核对患者的手术记录及既往病史，并与主治外科医生沟通损伤分区、核心缝线配置及修复强度、任何滑室（pulley）开窗情况，以及是否合并指神经修复。Hirpara 博士的屈肌腱修复采用曼彻斯特短背侧夹板（止于腕横纹），允许腕关节完全屈伸至 45°，掌指关节（MCP）限制在屈曲 30°，指间关节自由活动，全天佩戴六周。仅当出现指间关节屈曲畸形时，才加用夜间伸展支具。

第一阶段——曼彻斯特短夹板下的早期主动活动（第0至6周）

前六周旨在保护肌腱的愈合修复，同时保持肌腱滑动并防止手指因屈曲挛缩而僵硬。手部全天佩戴曼彻斯特短夹板（腕关节完全屈曲，背伸至45°，掌指关节（MCP）限制在30°，指间关节（IP）自由活动）。主动活动始于术后第4–5天。每次训练按固定顺序进行：首先进行被动指间关节屈曲，然后进行主动钩拳（从远端指间关节（DIP）开始，腕关节背伸），最后进行主动指间关节伸展（协同作用，抗挛缩），此时腕关节屈曲。禁止强行达到终末端活动范围，禁止进行抗阻屈曲。

致您的手治疗师：

教育与注意事项 - 全天佩戴曼彻斯特短夹板：腕关节完全屈曲，背伸至45°，掌指关节（MCP）限制在30°，指间关节（IP）自由活动；仅在锻炼和清洁时取下 - 术后第4–5天开始早期主动活动（EAM） - 禁止强行屈曲至终末端，禁止抗阻屈曲；禁止抓握、提举或牵拉 - 手部进行轻微的“安全”使用，但需避开受伤的手指 - 仅当出现指间关节屈曲畸形趋势时，夜间仅佩戴背伸支具

管理措施 - 伤口：按医嘱进行外科敷料处理；监测感染迹象 - 水肿：抬高患肢，轻柔控制指部水肿，管理粘连风险 - 每次训练的练习顺序：(1) 首先进行完全被动指间关节屈曲；(2) 主动钩拳，从远端指间关节（DIP）开始，腕关节背伸至45°；(3) 腕关节屈曲状态下的主动手指伸展（协同作用/肌腱固定作用，抗挛缩）；根据指导增加放置并维持至轻度握拳的动作 - 此阶段每周进行一次手治疗复查

进阶标准 - 伤口愈合；术后六周时修复完整；肌腱滑动功能保持良好；无明显的指间关节屈曲挛缩

第二阶段——拆除夹板，进行软组织与瘢痕处理（第6周）

第6周时拆除夹板。重点转向恢复完全的被动与主动活动范围，松解任何早期紧张，并处理瘢痕。此时尚未开始强化训练；仅当存在残留的屈曲畸形时，才使用夜间伸展夹板。

供您的手部治疗师参考：

评估 - 掌指关节（MCP）/近端指间关节（PIP）/远端指间关节（DIP）的主动与被动活动范围（ROM）；是否存在指间关节（IP）屈曲挛缩；肌腱滑动质量（评估是否存在粘连）；瘢痕与伤口复查

教育与注意事项 - 第6周停用夹板（仅对残留的指间关节屈曲畸形使用夜间伸展夹板） - 逐步增加轻度功能性使用；仍禁止抗阻握持或负重

管理 - 进行软组织拉伸以恢复完全的组合屈曲与伸展；伤口愈合后开始瘢痕管理 - 继续肌腱滑动练习；若粘连限制了肌腱的独立滑动，则引入阻挡练习 - 逐步增加手部轻度功能性使用

进阶标准 - 伤口与瘢痕稳定；接近完全的被动活动范围；滑动功能维持良好；准备好进行分级强化训练

第三阶段——强化与恢复（第6至12周）

随着修复组织更加成熟，开始进行分级拉伸和渐进性强化训练，并稳步增加负荷，直至实现无限制使用。预计在第10至12周时，根据标准达标后，可恢复完全、无限制的活动。

致手部治疗师：

评估 - 复合关节活动度（ROM）及任何残留的关节挛缩；握力与捏力与健侧对比；修复组织对分级负荷的反应

教育与注意事项 - 从约第6周开始进行分级拉伸和渐进性强化训练；逐渐增加负荷 - 在力量重建完成之前，避免突然的最大握力或抗阻负荷

管理 - 进行渐进性握力与捏力强化训练（从治疗泥过渡到分级阻力）；继续针对任何残留僵硬进行拉伸；根据需要继续进行瘢痕处理 - 逐步推进至第10–12周时的完全/无限制活动 - 一旦关节活动度和力量达到功能水平，且活动恢复适宜，可考虑出院；若恢复出现平台期或屈曲挛缩持续存在，请转诊回主治外科医生

完全活动恢复标准 - 功能性复合关节活动度；充足且接近对称的握力与捏力；无疼痛的无限制使用，通常在10–12周时达成

重返工作与活动

在佩戴夹板期间，鼓励尽早开始手部轻量、安全的使用（不包括受伤的手指），前提是没有任何动作会牵拉、抓握或牵拉修复部位。在最初几周需安排他人协助，因为术后六周内患手不得进行抓握、提举或搬运。夹板约在六周后拆除，此后开始进行轻量强化训练。

由于佩戴背侧夹板期间严禁驾驶，请为前六周安排交通接送。驾驶可在夹板拆除后（约六周）恢复，前提是您的抓握力和手指控制能力已达标，并经复查时获得医生许可。通常在十至十二周时可逐步恢复全部无限制活动，包括用力抓握及较重任务，具体进展由Hirpara医生及您的手部治疗师根据手指活动度及肌力综合评估，而非仅依据时间。

协议之后

本协议与诊所的一般康复建议并行；另请参阅术后疼痛管理、伤口护理和疤痕管理。上述分阶段计划反映了屈肌腱修复术后早期主动运动康复的已发表指导原则，您的持续康复将由Hirpara医生和您的手部治疗师根据您的手指进展情况个体化指导。

Evidence & references

Flexor Tendon Repair — Procedure Outcomes & Post-operative Rehabilitation (Manchester Short-Splint Early Active Motion)

Topic scope: post-operative rehabilitation after primary surgical repair of a flexor tendon in the finger (especially zone II) with a robust multi-strand core repair, mobilised on an early-active-motion (EAM) regimen using the Manchester short splint. This is a repair of a divided structure that is at its weakest in the first weeks, so — unlike a decompression — the rehab is a carefully graded protected-but-moving pathway: enough controlled tendon excursion to prevent adhesion and flexion contracture, without the forceful flexion that ruptures the construct.

Defining principle of the rehab here: a repaired flexor tendon must glide to heal well but must not be loaded hard while it is weak. The two competing failures are rupture (from forceful or resisted flexion) and adhesion / PIP flexion contracture (from too little controlled motion). The Manchester short splint resolves this tension by leaving the wrist free: holding the wrist in 45° of extension minimises the work of flexion (Savage) so a gentle active hook fist glides the tendon at low tension, while permitting wrist flexion harnesses the extensor tenodesis effect to drive active IP extension — the single most effective lever against the PIP flexion contracture that is the characteristic nuisance complication of zone II repair. The deliberate sequence each session (passive IP flexion → active hook fist from the DIP, wrist extended → active IP extension, wrist flexed) is what makes the regimen safe and anti-contracture.

A. PROCEDURE / REPAIR OUTCOMES (early active motion vs passive mobilisation)

Flexor tendon repair is technically demanding and historically complication-prone (rupture and adhesion). Modern multi-strand core repairs combined with early active motion have shifted outcomes decisively toward better motion, with the central trade-off being a small rupture risk against markedly better range and function.

Early active motion gives better finger motion than passive mobilisation, at a small rupture cost. A systematic review of controlled mobilisation after zone II repair found EAM regimens produced better total active motion than passive (Kleinert/Duran) protocols, with a modest increase in rupture (~5% vs ~4%) [Starr 2013]. The contemporary consensus favours active regimens with robust repairs. Moderate–strong (SR).
The Manchester short splint specifically improves IP extension without increasing rupture. A clinical audit comparing the Manchester short splint (MSS) with a traditional full-length dorsal splint in uncomplicated zone II repairs found less PIP extension deficit (median 15° vs 28° at 6 weeks, p=0.003; 6° vs 18° at 12 weeks), a greater DIP flexion arc (59° vs 30°), and more excellent/good Strickland grades with the MSS. Rupture was not significantly different (2/45, 4.4% MSS vs 3/76, 3.9% traditional) [Peck 2014]. The headline advantage is the reduction in PIP flexion contracture. Moderate (single-centre non-randomised audit, Level III–IV).
Forearm-based (wrist-blocking) splints constrain the very motion that prevents contracture. A comparison of splint designs found the Manchester short splint allowed greater PIP extension than forearm-based splints [Newington 2021], consistent with the mechanistic rationale that freeing the wrist enables the synergistic IP-extension move. Moderate.
Mechanistic basis. Positioning the wrist in ~45° extension minimises the work of flexion required for active digital flexion, lowering the tension on the repair during the active hook fist [Savage 1988]; allowing wrist flexion recruits the extensor tenodesis effect to achieve full active IP extension at low cost — the anti-contracture engine of the regimen. Mechanistic.

B. REHABILITATION / THERAPY EVIDENCE

The rehab questions are (1) active vs passive early mobilisation, (2) splint design, and (3) how to structure the session to prevent both rupture and contracture. The evidence supports a robust repair mobilised with early active motion, a short wrist-free splint, and a fixed safe exercise sequence delivered through formal hand therapy.

Early active motion is the modern default for robust repairs. Active regimens (partial-range combined passive/active, place-and-hold, true active flexion) outperform passive-only protocols on motion and are now standard where the core repair is strong enough to tolerate active glide [Tang 2021; Starr 2013]. Moderate–strong.
A defined, low-tension active sequence is what makes EAM safe. Therapy guidance emphasises passive flexion first (preconditioning the joints), place-and-hold / active hook fist to glide the tendon at minimal tension, and synergistic wrist-flexion finger-extension to recover IP extension — the explicit structure of the Manchester regimen [Neiduski & Powell 2019; Saint John protocol]. Moderate (consensus + protocol cohorts).
Splint design materially changes the contracture outcome. Shorter, wrist-free splinting that permits the synergistic extension move yields greater PIP extension than traditional or forearm-based dorsal splints [Peck 2014; Newington 2021]. Moderate.
All flexor repairs are routed through formal hand therapy. The regimen is exercise-order- and tension-sensitive and is delivered with weekly hand-therapy review through the six-week splinted phase; it is not a self-directed pathway. Consensus / standard of care.

Recovery trajectory (expected, evidence-anchored)

Phase	Window	Restraint	Hand use / therapy focus	Strength / load	Notes
I — Early active motion (in MSS)	Week 0–6	Manchester short splint full-time (full wrist flexion, extension to 45°, MCP block 30°, IPs free)	Start day 4–5; each session: passive IP flexion → active hook fist from the DIP (wrist extended) → active IP extension (wrist flexed); place-and-hold as guided; weekly therapy	No resisted flexion, no gripping/lifting; light safe use excluding the injured finger	EAM drives glide + anti-contracture; rupture risk highest now
II — Splint off, soft-tissue / scar	Week 6	Splint discontinued (night extension gutter only for residual IP flexion deformity)	Restore full passive/active ROM; scar management; tendon glides; blocking if adhesions	Still no resisted loading	PIP flexion contracture is the complication to chase down here
III — Strengthen / return	Week 6–12	Restrictions progressively lifted	Graded stretching; progressive grip/pinch strengthening (putty → resistance)	Build grip/pinch gradually	Return to full / unrestricted activity 10–12 weeks, criterion-based

(Phase windows mirror the precautions in the patient protocol; they are typical guides, not trial-derived deadlines.)

C. KEY CONTROVERSIES / EVIDENCE QUALITY

Active vs passive early mobilisation. EAM gives better motion than passive Kleinert/Duran regimens at a small rupture-rate cost (~5% vs ~4%); it is the contemporary default for strong core repairs [Starr 2013; Tang 2021]. Moderate–strong.
Manchester short splint vs traditional dorsal splint. The MSS audit shows clearly better IP extension and DIP flexion arc with no significant increase in rupture, but it is a single-centre, non-randomised audit (Level III–IV) — the authors themselves call for an RCT. The improvement is consistent with the mechanism (wrist-free synergistic extension), which raises confidence above the study design alone. Moderate; RCT recommended.
The PIP flexion contracture is the outcome that discriminates protocols. Rupture rates are broadly similar across modern regimens; what separates them is residual PIP extension loss, and that is where the short, wrist-free splint and the synergistic-extension move earn their place [Peck 2014; Newington 2021]. Moderate.
Repair strength gates the regimen. EAM is only safe with a robust multi-strand core repair; the protocol assumes that and is surgeon-confirmed per case (zone, suture configuration, pulley venting, concurrent nerve repair). Consensus.

D. EVIDENCE STRENGTH FLAGS (summary)

MODERATE–STRONG (SR): early active motion produces better finger motion than passive mobilisation after zone II repair, at a small rupture-rate increase (~5% vs ~4%) [Starr 2013]; modern partial-range active regimens are the contemporary standard [Tang 2021].
MODERATE: the Manchester short splint reduces PIP extension deficit (15° vs 28° at 6 wk, p=0.003) and improves DIP flexion arc without significantly increasing rupture (4.4% vs 3.9%) [Peck 2014]; greater PIP extension than forearm-based splints [Newington 2021]; defined low-tension exercise sequence [Neiduski & Powell 2019; Saint John].
MECHANISTIC / CONSENSUS: wrist 45° extension minimises work of flexion [Savage 1988]; wrist flexion harnesses the extensor tenodesis effect for active IP extension (anti-contracture); exact phase timings are typical guides, not trial-derived; single-centre non-randomised MSS evidence — an RCT is recommended.

CITATIONS

RAG corpus (180,000+ Orthopaedic articles)

Peck FH, et al. A comparative study of two methods of controlled mobilization of flexor tendon repairs in zone 2 (the Manchester short splint). Hand Ther. 2014. DOI: 10.1177/1758998314533306
Starr HM, et al. Flexor tendon repair rehabilitation protocols: a systematic review. J Hand Surg Am. 2013. DOI: 10.1016/j.jhsa.2013.06.025
Neiduski RL, Powell RK. Flexor tendon rehabilitation in the 21st century: a systematic review. J Hand Ther. 2019. DOI: 10.1016/j.jht.2018.06.001
Tang JB. Rehabilitation after flexor tendon repair and others: a safe and efficient update. J Hand Surg Eur Vol. 2021. DOI: 10.1177/17531934211037112
Tang JB, et al. (IFSSH flexor tendon committee report). J Hand Surg Eur Vol. 2014. DOI: 10.1177/1753193413500768
Newington L, et al. Splinting after flexor tendon repair: comparison of the Manchester short splint with forearm-based splinting on PIP joint extension. Hand Ther. 2021. DOI: 10.1177/17589983211017584

Flexor tendon rehabilitation literature (URLs)

Saint John flexor tendon protocol — early active motion regimen for zone II repair (protocol description and outcomes). PMC. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5142498/
Savage R. The influence of wrist position on the minimum force required for active movement of the interphalangeal joints. J Hand Surg Br. 1988 (mechanistic basis: wrist extension minimises the work of flexion). https://doi.org/10.1016/0266-7681(88)90258-2