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CC BY-NC-ND 4.0 · Rev Bras Ortop (Sao Paulo) 2023; 58(05): e681-e688
DOI: 10.1055/s-0043-1776133
Revisão Sistemática e Metanálise
Mão

Precoce ou tardio? O protocolo de reabilitação mais adequado para lesão na região ‘terra de ninguém’: Metanálise com análise sequencial de ensaios – Tendências de 20 anos

Article in several languages: português | English
Celleen Rei Setiawan 
1   Residente do Departamento de Ortopedia e Traumatologia, Hospital Geral Sanglah, Faculdade de Medicina, Universidade Udayana, Denpasar, Bali, Indonésia
,
Made Bramantya Karna
2   Equipe do Departamento de Ortopedia e Traumatologia, Hospital Geral Sanglah, Faculdade de Medicina, Universidade Udayana, Denpasar, Bali, Indonésia
› Author Affiliations Suporte Financeiro Os autores declaram que não receberam nenhum apoio financeiro de fontes públicas, comerciais ou sem fins lucrativos para conduzir o presente estudo.
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Resumo

Objetivo O objetivo deste estudo é analisar vários protocolos de reabilitação e determinar quais métodos produzem um melhor resultado.

Métodos Os relatórios dos bancos de dados foram pesquisados entre 1990 e 2020, usando PubMed, banco de dados da biblioteca Cochrane, Ovid, Medline e vários outros ensaios publicados. Uma análise estatística foi feita a partir do Review Manager e Trial Sequential Analysis (TSA).

Resultado A taxa média de re-ruptura é de 3,3% (n = 8) no protocolo combinado, e até 8% (n = 48) no protocolo de Movimento Ativo Controlado (MAC). As metanálises não encontraram diferença significativa entre Kleinert vs MAC na taxa de re-ruptura. Também não há diferença significativa entre Duran e MAC na taxa de re-ruptura. Na Trial Sequential Analysis (TSA), a curva z não cruza ambos os limites sequenciais de ensaio, será necessário um ensaio adicional com amostra maior. A TSA de contratura em flexão MAC vs Kleinert indicou que o protocolo MAC pode ser superior ao Kleinert para reduzir a incidência de contratura em flexão. Para a faixa de contratura média em flexão de 6,6% (n = 18) no MAC a 23,6% (n = 76) no protocolo Kleinert.

Conclusão A metanálise atual propôs que a técnica combinada resultará em menor incidência de re-ruptura e melhor resultado funcional em lesões da zona flexora II do que outras técnicas. O método MAC também resulta em menos contratura em flexão do que outros. No entanto, serão necessárias mais metanálises com estudos com amostras maiores para confirmar a conclusão desta revisão.

Palavras-chave

lesões dos tendões - cuidados pós-operatórios - procedimentos cirúrgicos operatórios

Trabalho desenvolvido no Departamento de Ortopedia e Traumatologia, Hospital Geral Sanglah, Faculdade de Medicina, Udayana Universidade, Denpasar, Bali, Indonésia.




Publication History

Received: 16 May 2022

Accepted: 05 May 2023

Article published online:
30 October 2023

© 2023. Sociedade Brasileira de Ortopedia e Traumatologia. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

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