CAJ | 학술논문

背景：国内在手部支具的研究方面与国外相比明显落后，难以获得广泛推广。伸指肌腱Ⅱ区结构较为复杂，损伤后治疗恢复效果较差，目前国内外对伸指肌腱Ⅱ区损伤主要通过石膏托、夹板以及高分子材料等固定，还没有一种针对这一区域损伤修复术后较为理想的固定锻炼支具。 　　目的：评价自制手部多功能外固定牵引康复支具对伸指肌腱Ⅱ区损伤的修复作用。 　　方法：将筛选出的76例伸指肌腱Ⅱ区损伤患者随机分成试验组和对照组，每组38例。试验组在常规伸指肌腱Ⅱ区损伤手术治疗的基础之上，给予适宜的康复教育加自制多功能外固定牵引康复支具牵引治疗；对照组给予手外科常规治疗加指导功能训练。治疗后1，2，3个月评价两组患者的指伸肌腱总主动活动度；治疗后2，3个月评价两组患者的手灵巧度及手的精细运动情况。 　　结果与结论：两组患者治疗后1，2，3个月时的肌腱总主动活动度相比差异有显著性意义(P <0.05)；两组患者治疗后2，3个月时明尼苏达手灵巧度及普渡手精细运动情况相比，差异均有显著性意义(P <0.05)。成本-效果分析结果得出两组的总花费差异无显著性意义(P >0.05)；而在以上3个功能评分上的比较，无论哪个功能评分每改善1分试验组的花费都较对照组少(P <0.05)，实现了低成本高效果的治疗。提示该支具在伸指肌腱Ⅱ区损伤修复术后的辅助锻炼治疗中起到了预防粘连及防止关节僵硬的发生的作用，同时也有助于改善手在关节活动度、灵活性及精细动作方面的能力，并且具有较高的治疗性价比。
배경：국내재수부지구적연구방면여국외상비명현락후，난이획득엄범추엄。신지기건Ⅱ구결구교위복잡，손상후치료회복효과교차，목전국내외대신지기건Ⅱ구손상주요통과석고탁、협판이급고분자재료등고정，환몰유일충침대저일구역손상수복술후교위이상적고정단련지구。 　　목적：평개자제수부다공능외고정견인강복지구대신지기건Ⅱ구손상적수복작용。 　　방법：장사선출적76례신지기건Ⅱ구손상환자수궤분성시험조화대조조，매조38례。시험조재상규신지기건Ⅱ구손상수술치료적기출지상，급여괄의적강복교육가자제다공능외고정견인강복지구견인치료；대조조급여수외과상규치료가지도공능훈련。치료후1，2，3개월평개량조환자적지신기건총주동활동도；치료후2，3개월평개량조환자적수령교도급수적정세운동정황。 　　결과여결론：량조환자치료후1，2，3개월시적기건총주동활동도상비차이유현저성의의(P <0.05)；량조환자치료후2，3개월시명니소체수령교도급보도수정세운동정황상비，차이균유현저성의의(P <0.05)。성본-효과분석결과득출량조적총화비차이무현저성의의(P >0.05)；이재이상3개공능평분상적비교，무론나개공능평분매개선1분시험조적화비도교대조조소(P <0.05)，실현료저성본고효과적치료。제시해지구재신지기건Ⅱ구손상수복술후적보조단련치료중기도료예방점련급방지관절강경적발생적작용，동시야유조우개선수재관절활동도、령활성급정세동작방면적능력，병차구유교고적치료성개비。
BACKGROUND:Research on hand braces is relatively backward, which is difficult to be promoted widely. Zone II extensor tendon has a complex structure, and poor recovery is commonly seen after injury. The main treatment for zone II extensor tendon injury is the fixation with plaster slab, plywood and polymer materials, and up to now, there is no ideal brace for zone II extensor tendon injury. OBJECTIVE:To evaluate the effect of home-made multi-function hand brace on the repair of zone II extensor tendon injury. METHODS:Seventy-six patients with zone II extensor tendon injury were randomly divided into test group and control group, with 38 in each group. In the test group, patients were given appropriate rehabilitation education and multi-function hand brace based apart from conventional hand surgery on zone II extensor tendon; in the control group, patients underwent conventional hand surgery and guiding functional training. Total active motion of the extensor tendons of fingers were evaluated at 1, 2, 3 months after treatment; and the manual dexterity and fine motor of the hand were assessed at 2 and 3 months after treatment. RESULTS AND CONCLUSION:The difference in the total active motion of extensor tendons of fingers was of great significance between the two groups at 1, 2, 3 months after treatment (P < 0.05). The Minnesota manual dexterity and fine motor of the hand also showed significant differences between the two groups at 2 and 3 months after treatment (P < 0.05). Patient’s cost-effectiveness analysis results showed that the total cost of the two groups had no statistical significance (P> 0.05), but less cost was used for one point increase in the above-mentioned three functional scores of the test group than the control group (P < 0.05), indicating the implementation of cost-effective treatment. This home-made brace can prevent adhesions and anchylosis during the postoperative auxiliary exercise; meanwhile, it can improve the range of motion, flexibility and fine motor ability of the hand and has a higher cost performance in the postoperative adjuvant exercise therapy of zone II extensor tendon injury.