手外伤患者继发性肩部功能障碍原因分析与康复对策

摘要

目的 探讨手外伤患者发生继发性肩部功能障碍的原因,提出有效对策.方法 选取我科自2014年5月至2016年5月收治的手外伤术后康复患者167例,其中男性128例,女性39例;年龄20～58岁,平均(34.3±7.8)岁.排除合并肩部受伤史患者.统计其发生肩部并发症的时间、类型,分析其发生原因,并根据康复开始时期分组,比较康复疗效.结果 167例患者中共有43例发生肩部并发症,发生率为25.75％.肩部并发症发生时间为伤后4～8周.发生肩部并发症者平均年龄为34.81岁,与未发生者平均年龄大致相等,经卡方检验提示差异无统计学意义.3个月内进行系统康复训练的患者,肩关节功能改善的优良率100％;3～6个月内进行系统康复训练的患者,优良率95.8％;6～12个月内进行系统康复训练的患者,优良率为27.3％.结论 如果发生继发性肩部功能障碍,3个月内通过综合康复治疗效果较佳,如超过6个月再进行康复治疗效果欠佳.手外伤后康复早期介入能显著减少肩部功能障碍的发生率.%Objective To investigate the reasonsof shoulder dysfunctioncomplications developed in patients with hand injury and the treatments for these patients.Methods 167 patients were included in this study and received rehabilitation therapy in our department from 2014 to 2016.Among the patients.128 of them were male and 39 were female.The age range from 20 to 58 with an average of 34.3.The patientswho had a history of shoulder injury were excluded.Considering the time and the type of the developed shoulder dysfunctioncomplieations by reviewingthe patients' medical history,the patients were divided into three groups according to the time point for starting the rehabilitation therapy.Results 43 patients (25.75％) developed shoulder dysfunctioncomplications 4～8 weeks after they had the hand injury.The mean age of the patients with shoulder complications was 34.81 years,roughly equal to the average age of the patient without shoulder dysfunctioncomplications.And the difference was not statistically significant by the chi-square test.The optimal rate of improvement of shoulder joint function was 100％ in the group of 3 months after the system rehabilitation training.Inthe 3～6 months of rehabilitation training group,the optimal rate was 95.8％.Inthe 6～ 12 months of rehabilitation training group,the optimal rate was 27.3 ％.Conclusion As compared the patients who take the therapy 6 months after hand injury,the shoulder complication significantly relieved in patients who received the therapy in 3 month after injury.Early rehabilitation therapy can significantly reduce the chance of shoulder dysfunction complication developed in patients with hand injury.