摘要
目的观察应用手掌深筋膜下注射联合手指对掌训练对掌腱膜挛缩症功能恢复的影响。方法选择掌腱膜挛缩症患者10例。治疗方案:(1)手指对掌功能训练项目:每天康复训练二次。4个手指(食指至小指)相对对掌,双掌合并,4指的掌指关节伸直至中立位,持续5~10 s,5次/组,共5组,共6周。(2)从第5周训练开始,手掌深筋膜下注射,环指和小指手掌部结节及/或条索处为穿刺点。注射药物:0.5%利多卡因1 ml+甲强龙20 mg+生理盐水至3 ml。注射疗程:1次/周,共2次。观察指标:(1)4指对掌最小屈曲角度(最大伸直能力);(2)维持最小被动屈曲角度(最大伸直状态下)的时间;(3)最小被动屈曲角度(最大伸直状态下)维持最长时间点的VAS评分值;所有掌指关节角度按中立位0°计算法表示。观察时间点:(1)训练前(T0)、(2)训练4周后(T1)、(3)训练+注射治疗2周后(T2)。结果训练前(T0)与训练4周后(T1)三项指标比较结果显示:(1)4指对掌最小屈曲角度训练后明显缩小,差异有统计学意义(P<0.05);(2)维持最小被动屈曲角度的时间有所减少,但无显著性差异;(3)最小屈曲角度维持最长时间点的VAS评分值无明显改善。训练4周后(T1)与训练+注射治疗2周后(T2)三项指标比较结果显示:(1)4指对掌最小屈曲角度在训练+注射治疗2周后,与单纯训练4周后有明显缩小,差异有统计学意义(P<0.05);(2)维持最小被动屈曲角度的时间明显减少,差异有显著性(P<0.05);(3)最小被动屈曲角度维持最长时间点的VAS评分值在训练+注射治疗2周后较单纯训练4周的明显减低,数据差异显著(P<0.05)。结论手掌深筋膜下注射联合手指对掌训练项目可以更有效地缓解轻中度掌腱膜挛缩症临床症状,改善患手功能。
Objective To observe the effect of the treatment with injection under profundal fascia in palm of the hand combined w gers opposing training on function recovery for patients with Dupuytrens contracture. Methods Ten patients with Dupuytrens contracture, 8 male and 2 female, aged from 65 to 78 years old, were enrolled into the study. The therapeutic schedule included programs as followed. Firstly, fingers opposing training was performed according to the way that four fingers in one hand were against four fingers in another hand in the opposing direc-tion with metacarpophalangeal joint in neutral position for 5 to 10 seconds. There were five such actions in a round and five rounds in a course. Two courses were needed in a day and the therapeutic duration was 6 weeks. When the fifth week with fingers opposing training began, the injec-tion under profundal fascia in palm of the hand was performed. The injection sites were at the palm nodules and/or bands of the ring finger and the little finger and lidocaine 5mg with methylprednisolone 20mg in 0. 9% sodium chloride 3 ml were used. The injection was once a week and 2 weeks were needed. Items were observed as followed. Firstly, the minimum flexion angle for four opposing fingers （ FLAOF） （the neutral position was calculated as ＂0＂ degree） , the time to maintain in the minimum flexion angle （TMMFL） , and the visual analogue scale of pain while in maintai-ning the minimum flexion angle at the longest time point （VAS - FLA） were observed. FLAOF, TMMFL, and VAS - FLA were observed at the time point before the training （TO） , four weeks after the training （T1） , and two weeks after the injection （T2）. Results FLAOF at T1 was sig-nificantly lower than that at TO （ P 〈0. 05） , but there was no difference in TMMFL and VAS - FLA between TO and T1 （ P 〉0. 0 5） . FLAOF, TMMFL, and VAS - FLA at T2 were significantly lower than those at T1 （ P 〈 0. 0 5） . Conclusion The treatment with injection under profundal fascia in palm of the hand combined with fingers opposing training could effectively relieve clinical symptoms of patients with mild or moderate Du- puytrens contracture and improve the diseased hand function.
出处
《临床和实验医学杂志》
2017年第15期1559-1561,共3页
Journal of Clinical and Experimental Medicine
关键词
掌腱膜挛缩症
注射治疗
手掌深筋膜
手指对掌训练
Dupuytrens contracture
Injection treatment
Profundal fascia in palm of the hand
Fingers opposing training
