摘要
目的观察功能训练联合自制手屈曲训练带治疗手背部烧伤后瘢痕挛缩的疗效。方法2013年3月-2015年2月，选择笔者单位收治的46例手背部深Ⅱ～Ⅲ度烧伤后瘢痕患者，按患者意愿分为常规训练组18例和联合训练组28例。创面愈合后2周，常规训练组患者行手功能训练和佩戴自制压力手套，联合训练组在常规训练组基础上另增加佩戴自制手屈曲训练带（由尼龙带、屈曲带和魔术贴组成），均持续治疗3个月。治疗前及治疗后，采用温哥华瘢痕评定量表评定患手瘢痕情况，采用手总主动活动度（TAM）法评定患手关节活动度，采用Carroll上肢功能评定法评定息手功能。对数据行t检验、X2检验及Mann-WhitneyU检验。结果（1）常规训练组患者治疗前瘢痕情况评分为（10．0±1．9）分，治疗后为（4．4±1．4）分，改善分为（5．6±1．0）分；联合训练组患者治疗前瘢痕情况评分为（10．5±1．8）分，治疗后为（4．6±1．4）分，改善分为（5．9±1．2）分。2组患者瘢痕情况改善分相近（t=0．834，P〉0．05）。常规训练组和联合训练组患者治疗后瘢痕情况评分均较治疗前明显降低（t值分别为14．014和10．003，P值均小于0．01）。（2）治疗前，常规训练组患者TAM评级优良比为2／9，联合训练组患者TAM评级优良比为3／14，二者相近（X2=2．140，P〉0．05）；治疗后，联合训练组患者TAM评级优良比为6／7，明显高于常规训练组的5／9（X2=0．023，P：0．038）。常规训练组和联合训练组患者治疗后TAM评级优良比均较治疗前明显提高（Z值分别为-2．023和-4．780，P值均小于0．05）。（3）联合训练组患者手功能改善分为（26±12）分，明显高于常规训练组的（15±7）分（t=3．278，P=0．002）。常规训练组和联合训练组患者治疗后手功能评分均较治疗前明显提高（t值分别为2．628和6．125，P值均小于0．05）。治疗前2组患者手功能评级比较，差异无统计学意义（Z=-0．286，P〉0．05），治疗后联合训练组患者手功能评级优于常规训练组（Z=-1．993，P=0．046）。常规训练组、联合训练组患者治疗后手功能评级均较治疗前明显提高（z值分别为-2．717和-4．998，P值均小于0．01）。结论对手背部深度烧伤后瘢痕患者，早期应用功能训练联合手屈曲训练带进行治疗，可以显著改善患手关节活动度，促进手功能恢复，其效果优于单纯功能训练。
Objective To observe the effects of functional training combined with self-made hand flexing training band in treatment of scar contracture after burn injury of dorsal hand. Methods Forty-six patients with scar contracture after deep partial-thickness or full-thickness burn injury of dorsal hand hospi- talized in our department from March 2013 to February 2015 were divided into routine training group （ RT, n = 18） and comprehensive training group （CT, n = 28） according to their willingness. Two weeks after the wounds were healed, patients in group RT were treated with functional training of hands and self-made pres- sure gloves, while patients in group CT were treated with self-made hand flexing training band （ consisting of nylon strap, flexing band, and velcro） on the basis of those in group RT. All patients were treated for 3 months. Before and after treatment, sear condition of affected hands was assessed with Vancouver Scar Scale （VSS）. The range of motion of joints of affected hands was measured by Total Active Movement （TAM） Scale. The function of affected hands was evaluated by Carroll Upper Extremity Function Test. Data were processed with t test, chi-square test, and Mann-Whitney U test. Results （ 1 ） The score of VSS in pa- tients of group RT was （10.0 ±1.9） points before treatment and （4.4± 1.4） points after treatment, with the improved score of （5.6± 1.0） points. The score of VSS in patients of group CT was （10.5 ± 1.8） points before treatment and （4.6 ± 1.4） points after treatment, with the improved score of （5.9± 1.2） points. There was no statistically significant difference in the improved score of patients between the two groups （ t = 0. 834, P 〉 0.05 ）. The score of VSS in patients of groups RT and CT after treatment was sig- nificantly lower than that before treatment （ with t values respectively 14. 014 and 10. 003, P values below 0.01 ）. （2） Before treatment, the ratios of excellent and good results according to TAM were 2/9 in patients of group RT and 3/14 in group CT, with no statistical differences between them （ X 2 = 2. 140, P 〉 0.05）. After treatment, the ratio of excellent and good results according to TAM in patients of group CT （6/7） was higher than that in group RT （5/9, X 2 = 0. 023, P = 0. 038）. The ratios of excellent and good results ac- cording to TAM in patients of groups RT and CT after treatment were significantly higher than those before treatment （with Z values respectively - 2. 023 and - 4. 780, P values below 0.05 ）. （3） The improved score of hand function in patients of group CT was （26± 12） points, which was higher than （ 15 ±7） points in group RT （ t =3.278, P = 0. 002）. The score of hand function in patients of groups RT and CT after treatment was significantly higher than that before treatment （with t values respectively 2. 628 and 6. 125, P values below 0.05）. There were no significant differences in grades of hand function of patients between the two groups before treatment （ Z = - 0. 286, P 〉 0.05）. After treatment, the grade of hand function in pa- tients of group CT was higher than that in group RT（ Z = - 1.993, P =0.046）. The grades of hand func- tion in patients of groups RT and CT after treatment were significantly higher than those before treatment （ with Z values respectively - 2.717 and - 4. 998, P values below 0.01 ）. Coneluslons For patients with scar contracture after burn injury of dorsal hand, early functional training combined with hand flexing training band can improve the range of motion of hand joints and functional recovery of hand, and the result was bet- ter than functional training alone.
作者
朱婵
易南
石梦娜
梁艳艳
周永博
党瑞
齐宗师
赵海洋
Zhu Chan Yi Nan Shi Mengna Liang Yanyan Zhou Yongbo Dang Rui Oi Zongshi Zhao Haiyang.(Burn Center of PLA, Department of Burns and Cuta- neous Surgery, Xifing Hospital, the Fourth Military Medical University, Xi＇an 710032, China)
出处
《中华烧伤杂志》
CAS
CSCD
北大核心
2017年第7期426-430,共5页
Chinese Journal of Burns
关键词
烧伤
手
瘢痕
功能训练
手屈曲训练带
Burns
Hand
Cicatrix
Functional training
Hand flexing training band
