早期超短波联合序贯压力治疗对手深度烧伤后功能恢复的作用
조기초단파연합서관압력치료대수심도소상후공능회복적작용
Effects of early treatment with ultrashort wave combined with sequential pressure on functional recovery of deeply burned hands
  • 万方数据
    中华烧伤杂志 중화소상잡지
    16
    2014年 6期 472-476 ,共5页

    石梦娜%李娜%王冰水%易南%粱艳艳%朱婵%党瑞%胡大海

    석몽나%리나%왕빙수%역남%량염염%주선%당서%호대해

    烧伤%手%功能恢复%压力治疗%超短波 燒傷%手%功能恢複%壓力治療%超短波
    소상%수%공능회복%압력치료%초단파
    Burns%Hand%Recovery of function%Pressure therapy%Ultrashort wave
    目的 研究手深度烧伤创面愈合后早期进行超短波联合序贯压力治疗,对患手功能恢复的影响. 方法 2012年7月-2013年6月,笔者单位收治65例单侧手部深Ⅱ～Ⅲ度烧伤患者.创面基本愈合后10～31 d,根据患者意愿35例患者进行主动运动、超短波、序贯压力治疗以及佩戴压力手套,设为综合治疗组;另30例患者仅行主动运动训练及佩戴压力手套,设为常规治疗组.治疗前及治疗4周后,观察患手外观,测量患手拇指、示指、中指根部及掌横纹、腕横纹处周径了解患手肿胀情况,采用Carroll上肢功能评定标准对患手功能进行评分及评级.对数据行t检验及秩和检验.结果 (1)治疗4周后,综合治疗组30只患手外形较治疗前改善并接近正常对侧手外观,5只患手出现掌指关节与指间关节挛缩畸形;常规治疗组17只患手外观较治疗前无明显变化,13只患手出现掌指关节过伸、指间关节屈曲及拇指内收畸形.(2)治疗4周后,综合治疗组患手拇指、示指、中指根部及掌横纹、腕横纹处周径较治疗前显著缩短(t值为3.26 ～ 4.24,P值均小于0.01),常规治疗组患手拇指、中指根部及腕横纹处周径较治疗前显著缩短(t值为2.02 ～ 2.44,P值均小于0.05).综合治疗组治疗前后患手拇指、示指、中指根部及掌横纹、腕横纹处周径差值分别为(0.491 ±0.022)、(0.583±0.089)、(0.486±0.021)、(1.100±0.076)、(0.751±0.053) cm,明显高于常规治疗组的(0.306±0.021)、(0.277±0.022)、(0.320±0.027)、(0.700±0.052)、(0.483 ±0.048)em(t值分别为5.94、3.11、5.02、4.22、3.68,P值均小于0.01).(3)治疗4周后,综合治疗组与常规治疗组患手功能评分较治疗前显著增高(t值分别为14.40、4.00,P值均小于0.001),功能评级较治疗前显著提高(u值分别为6.93、3.29,P值均小于0.01).综合治疗组治疗前后患手功能评分差值为(51.1±2.2)分,显著高于常规治疗组的(32.5±4.8)分(t=3.52,P＜0.001). 结论 手深度烧伤创面愈合后早期,行常规康复治疗的同时联合超短波及序贯压力治疗,可明显改善患手肿胀情况,为进行主动运动以及后期系统康复治疗提供有利条件.
    목적 연구수심도소상창면유합후조기진행초단파연합서관압력치료,대환수공능회복적영향. 방법 2012년7월-2013년6월,필자단위수치65례단측수부심Ⅱ～Ⅲ도소상환자.창면기본유합후10～31 d,근거환자의원35례환자진행주동운동、초단파、서관압력치료이급패대압력수투,설위종합치료조;령30례환자부행주동운동훈련급패대압력수투,설위상규치료조.치료전급치료4주후,관찰환수외관,측량환수무지、시지、중지근부급장횡문、완횡문처주경료해환수종창정황,채용Carroll상지공능평정표준대환수공능진행평분급평급.대수거행t검험급질화검험.결과 (1)치료4주후,종합치료조30지환수외형교치료전개선병접근정상대측수외관,5지환수출현장지관절여지간관절련축기형;상규치료조17지환수외관교치료전무명현변화,13지환수출현장지관절과신、지간관절굴곡급무지내수기형.(2)치료4주후,종합치료조환수무지、시지、중지근부급장횡문、완횡문처주경교치료전현저축단(t치위3.26 ～ 4.24,P치균소우0.01),상규치료조환수무지、중지근부급완횡문처주경교치료전현저축단(t치위2.02 ～ 2.44,P치균소우0.05).종합치료조치료전후환수무지、시지、중지근부급장횡문、완횡문처주경차치분별위(0.491 ±0.022)、(0.583±0.089)、(0.486±0.021)、(1.100±0.076)、(0.751±0.053) cm,명현고우상규치료조적(0.306±0.021)、(0.277±0.022)、(0.320±0.027)、(0.700±0.052)、(0.483 ±0.048)em(t치분별위5.94、3.11、5.02、4.22、3.68,P치균소우0.01).(3)치료4주후,종합치료조여상규치료조환수공능평분교치료전현저증고(t치분별위14.40、4.00,P치균소우0.001),공능평급교치료전현저제고(u치분별위6.93、3.29,P치균소우0.01).종합치료조치료전후환수공능평분차치위(51.1±2.2)분,현저고우상규치료조적(32.5±4.8)분(t=3.52,P＜0.001). 결론 수심도소상창면유합후조기,행상규강복치료적동시연합초단파급서관압력치료,가명현개선환수종창정황,위진행주동운동이급후기계통강복치료제공유리조건.
    Objective To study the effects of ultrashort wave combined with sequential pressure treatment on the functional recovery of deeply burned hands in the early stage of healed wounds in hands.Methods Sixty-five patients with burn of unilateral hand were hospitalized from July 2012 to June 2013 in our center.Injured hands of 35 patients were treated with active movement,ultrashort wave,sequential pres sure therapy,and pressure gloves,and the other 30 patients were treated with active movement and pressure gloves 10-31 days after the wounds were healed according to the will of patients.The former 35 patients were regarded as comprehensive treatment (CT) group,and the latter 30 patients were regarded as routine treatment (RT) group.Before treatment and 4 weeks after treatment,the appearance of injured hands was observed; the circumference of the proximal segment of thumb,index,and middle fingers and that of the palmar crease and wrist crease were measured to evaluate swelling of injured hand ; score and grade of function of injured hands were evaluated with a Carroll Upper Extremity Functional Test.Data were processed with t test and rank sum test.Results (1) Four weeks after treatment,appearance of 30 injured hands in group CT was improved,which was close to that of the normal hand of each patient,while contracture deformity of metacarpophalangeal joints and interphalangeal joints was observed in the other 5 injured hands.Four weeks after treatment,no obvious change in the appearance of 17 injured hands in group RT was observed compared with that before treatment,while hyperextension of metacarpophalangeal joints,flexion of interphalangeal joints,and adduction deformity of thumb were observed in the other 13 hands.(2) Four weeks after treatment,the circumferential values of the proximal segment of thumb,index,and middle fingers and the palmar crease and wrist crease of injured hands in group CT were respectively lower than those before treatment (with t values 3.26-4.24,P values below 0.01),and the circumferential values of the proximal segment of thumb and middle fingers and the wrist crease of injured hands in group RT were respectively lower than those before treatment (with t values 2.02-2.44,P values below 0.05).The difference values of circumference values of the proximal segment of thumb,index,and middle fingers and the palmar crease and wrist crease of injured hands between before treatment and 4 weeks after treatment were respectively (0.491 ±0.022),(0.583±0.089),(0.486±0.021),(1.100±0.076),(0.751 ±0.053) cm in group CT,which were significantly higher than those in group RT [(0.306 ± 0.021),(0.277 ± 0.022),(0.320±0.027),(0.700±0.052),(0.483 ±0.048) cm,with t values respectively 5.94,3.11,5.02,4.22,3.68,P values below 0.01].(3) Four weeks after treatment,scores of function of injured hands in groups CT and RT were respectively higher than those before treatment (with t values respectively 14.40 and 4.00,P values below 0.001),and the grades of function of injured hands were respectively improved (with u values respectively 6.93 and 3.29,P values below 0.01).The difference value of scores of function of injured hands between before treatment and 4 weeks after treatment was (51.1 ± 2.2) points in group CT,which was significantly higher than that of group RT [(32.5 ±4.8) points,t =3.52,P ＜0.001].Conclusions Ultrashort wave combined with sequential pressure and routine rehabilitation treatment of deeply burned hands in the early stage after wounds in hands are healed can obviously reduce the swelling of injured hands,which provides a favorable condition for active movements and systematic rehabilitation treatment later.
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