促进屈肌腱滑动对手外伤患者僵硬手功能恢复的影响

摘要

Objective:To observe the effect of flexor tendon gliding training on stiff hands' functional recovery in patients post hand injury.Method:Thirty patients post hand injury were divided into observation group or control group according to the sequence of admission.The control group including 32 fingers of 15 patients were trained by comprehensive rehabilitation therapy and occupational therapy.While the observation group including 34 fingers of 15 patients were trained by the program of promoting the flexor tendon gliding in addition to the comprehensive rehabilitation therapy.The protocols of this program included joint orientation training,hooking,making a fist,making a fist at right angles,gliding the superficial flexor tendon independently,and just flexing the metacarpophalangeal (MCP) joints.The CARROLL hand function scores were assessed the total active motion (TAM) of each finger was measured the good and excellent rate was counted.Result:There was significant difference of CARROLL scores between observation group and control group(P＜0.05).The difference of TAM scores between observation group and control group has statistical significance (P＜0.001).The good and excellent rate of observation group was 70.6％,no patient presented poor function; however,the rate of control group was 34.4％,and 2 patients presented poor function.Difference of the rates was significant between these two groups (P＜0.001).Conclusion:For the patients with hand injury who had not accepted rehabilitation in time,the treatment of adhesion of flexor tendon should be enhanced,mobilization,physiotherapy,occupational therapy and flexor tendon gliding should be administered simultaneously to get better hand function.%目的:研究对手外伤手僵硬患者施行促进屈肌腱滑动的训练方案后,手功能恢复的情况.方法:30例手外伤所致手功能障碍患者随机分为观察组和对照组,对照组15例,32指,进行综合的康复治疗及作业治疗活动.观察组15例,34指,在综合康复治疗的基础上,进行促进屈肌腱滑动的训练方案.具体做法包括:关节定位训练,勾拳、握拳、直角握拳训练,屈浅肌腱的单独滑动训练,单独的掌指关节关节屈曲训练.疗程结束后采用CASRROLL手功能测试表测试手的整体功能,采用国际手外科学会推荐的总主活动度(TAM)对每个手指进行测定并统计优良率.结果:治疗后观察组和对照组间的CARROLL值经t检验,t=4.971,P＜0.05,差异有显著性意义,观察组优于对照组.而两组患者治疗后的TAM值,经t检验,t=3.45,P＜ 0.001,差异亦有显著性意义.观察组手指TAM的优良率为70.6％,无一例患者功能为差.对照组手指TAM的优良率为34.4％,有2例患者功能被评为差.优良率经秩和检验,Z=3.262,P＜0.001,差异有显著性意义.结论:对于手外伤后没有及时得到康复训练而手功能障碍的患者,在施行关节松动,物理治疗,作业治疗等康复治疗同时,也要注意屈肌腱滑动差的问题,应该促进肌腱的滑动,以取得更好的手功能恢复.