臂丛神经损伤的康复治疗

臂丛神经损伤在周围神经损伤中较为常见 ,往往造成上肢严重残疾。康复治疗在臂丛神经损伤治疗中可起到促进肢体功能恢复的重要作用。近年来我科对40例臂丛神经损伤患者进行了系统的综合康复治疗和临床观察 ,取得较满意的疗效 ,现报告如下。1　资料和方法1.1　临床资料本组病例男 35例 ,女 5例 ;年龄 6～47岁 ,平均 ( 2 5 .35± 13 .0 5 )岁 ;病程 2 3ｄ～ 16年 ,车祸伤 2 0例 ,产伤 10例 ,机器伤7例 ,运动伤 3例 ;损伤左侧者 17例 ,右侧者 2 3例 ;臂丛上部损伤 2 5例 ,下部损伤 9例 ,全臂丛损伤 6例 ;完全性损伤 17例 ,不完全性损伤 2 3例 ;…     

规范化康复治疗对臂丛神经损伤后功能恢复的影响

[目的]探讨规范化康复治疗对臂丛神经损伤后病人康复疗效的影响。[方法]采用便利抽样法选取骨科臂丛神经损伤病人35例,依据治疗意愿分为观察组和对照组,对照组术后自行居家接受康复治疗,观察组在我院接受4个疗程的规范化康复治疗,比较两组病人的康复疗效。[结果]观察组有效率高于对照组（P〈0.05）。[结论]对臂丛神经损伤病人实施规范化康复治疗能有效提高术后康复疗效。     

肝移植后并发臂丛神经损伤的康复治疗1例报告

1例“肝炎后肝硬化、肝功能衰竭”患者在我院施行异体原位肝移植手术,因术中置静脉转流泵及体位摆放欠佳,术后患者出现肩关节活动障碍、伸腕及手指抓握不能、双上肢皮肤感觉异常等臂丛神经损伤表现,经过综合康复治疗后,双上肢功能恢复正常。1资料与方法患者于2000年9月行原位肝移植术。患者取平卧位,双上肢固定在外展180°位。术中采用静脉转流泵,于左侧股静脉、门静脉及左侧腋静脉置管,手术经过顺利,历时14h。患者术后出现左肩前屈、外展不能,左上肢疼痛(以前臂内侧最明显),左手拇、食、中三指屈曲不能、麻木,右侧垂腕,患者日常生活活动严…     

早期规范化电刺激疗法在臂丛神经损伤中的疗效观察

目的观察早期规范化电刺激疗法在臂丛神经损伤中的治疗效果。方法将臂丛神经损伤患儿随机分成两组,实验组采用规范化电疗刺激疗法,对照组按常规方法进行治疗,每天一次,20天为一疗程,共3个疗程。两组患儿均为保守治疗,以物理因子治疗即电刺激疗法为主,配合运动训练、手功能训练和营养神经药物等综合治疗。评估指标:(1)肌电图显示的神经传导速度、波幅、运动单位募集、收缩时间;(2)临床观察:如肌力、肌张力、肌肉萎缩(测量);(3)手功能评估;(4)显效时间:评估患儿治疗3个疗程后的效果。结果实验组四项评估指标明显比对照组好。结论规范化电刺激疗法对臂丛神经损伤患儿的治疗效果明显优于盲目、无序的电刺激疗法治疗效果。     

臂丛神经损伤术后患者的康复护理

目的了解康复护理对臂丛神经损伤术后患者的患肢功能恢复的作用.方法对50例臂丛神经损伤患者随机分为康复组和对照组,康复组采用激光照射、运动疗法、电刺激及电体操疗法等康复治疗方法,对照组不采用康复治疗,其他治疗护理方法相同.结果康复组术后神经再生及功能恢复均优于对照组(χ2=4.37,P<0.05).结论分阶段综合康复护理是辅助臂丛神经损伤术后患者功能恢复的一种有效方法.     

综合康复治疗小儿臂丛神经损伤效果分析与研究

目的:观察综合康复治疗对小儿臂丛神经损伤患儿臂丛神经功能的影响及疗效。方法:选取符合标准的58例小儿臂丛神经损伤患儿分组研究,按照治疗方式的不同分为研究组(30例,接受综合康复治疗3个月)和对照组(28例,接受常规康复治疗3个月),观察2组疗效、不良事件发生情况、臂丛神经功能评分变化情况。结果:研究组治疗总有效率为96.67%,高于对照组的71.43%(P0.05)。研究组不良事件发生率为3.33%,低于对照组的25.00%(P0.05)。治疗:2组臂丛神经功能评分均高于治疗前,其中研究组评分(10.28±1.92)分显著高于对照组的(7.53±1.74)分(P0.05)。结论:综合康复治疗小儿臂丛神经损伤疗效确切,可改善患儿臂丛神经功能,减少畸形、肌肉萎缩事件的发生,具有推广应用价值。     

综合康复治疗婴幼儿分娩性臂丛神经损伤104例

2004年2月~2014年3月在我院就诊的分娩性臂丛神经损伤的患儿104例,均符合臂丛神经损伤的诊断标准[1]。并经临床康复评定及神经肌电图检查确诊。其中男65例,女39例;年龄4d~18个月;上干型损伤51例,下干型损伤19例,全臂丛损伤34例。104例患儿均采用综合康复治疗:1电针:取患侧肩髃、肩贞、肩臑、臂臑、天宗、曲池、手三里、小海、外关、天泉、列缺、合谷、阳池、后溪、八邪等穴,针刺得气后,选取2~4对     

蜡疗对婴儿臂丛神经损伤的疗效

郑州市儿童医院2001—01／2003—01对26例臂丛神经损伤患儿在常规康复治疗基础上加用蜡疗，取得了较好疗效。     

婴幼儿分娩性臂丛神经损伤的综合康复

因胎位不正或体重过重，使臂丛在分娩时受牵拉和压迫而致伤，其所支配的肌肉立即瘫痪，并逐渐出现肌肉萎缩。采用针刺、穴位注射、按摩、运动、蜡疗、神经肌肉治疗仪等综合治疗婴幼儿分娩性臂丛损伤，效果满意。     

植入神经起搏器治疗臂丛神经损伤病人的护理

臂丛神经损伤是周围神经损伤最严重的一种,常常导致病人上肢功能的部分或完全丧失,遗留终生残疾[1].多年来国内外学者的大量实验和临床研究不断提供了电刺激促进周围神经再生的相关资料及临床作用[2].神经肌电刺激治疗, 不但可促进周围神经的再生[3-5],改善受损神经局部血液循环,缓解或消除疼痛,提高神经肌肉的兴奋性,恢复神经功能,而且能有效防止肌肉萎缩[6].我院现已成功开展10例植入起搏器治疗臂丛神经损伤的手术,现将护理报告如下.     

臂丛神经损伤患者生活质量及影响因素调查

目的 调查臂丛神经损伤患者术后生活质量,并分析其影响因素.方法 采用WHO生活质量测定量表简表(WHOQOL-BREF)、家庭亲密度和适应性量表中文版(FACESⅡ-CV),对103例臂丛神经损伤手术后患者进行问卷调查.结果 臂丛神经损伤患者生活质量得分为(65.78±15.24)分,生理、心理和环境领域得分均低于常模(P＜0.05或P＜0.01).回归分析显示,年龄、受伤侧与优势手是否为同侧、上肢功能得分、家庭亲密度得分、家庭人均月收入是臂丛神经损伤患者生活质量的影响因素.结论 臂丛神经损伤患者的生活质量明显下降,且影响因素较为复杂,应联合家属加强对患者生理和心理双方面的护理.     

应用Oram自理学说提高全臂丛神经损伤患者自理能力

美国护理学家（Dorothea Elizabeth Oram）提也了自理理论,自理是人们以特定的方式维持自身结构完整和功能正常的进行维持正常生长发育的过程,她将患者定为自理缺陷的人。全臂丛神经损伤是指C5-T1脊神经根的损伤,临床表现为上肢肌肉瘫痪及感觉消失,伸屈肘及腕桡反射消失。     

Reflections of patients and therapists on a multidisciplinary rehabilitation programme for persons with brachial plexus injuries

Purpose: There is lack of knowledge, evidence, and guidelines for rehabilitation interventions for persons with neuralgic amyotrophy (NA) or brachial plexus pathology. A first pilot study, evaluating the effect of an integrated rehabilitation programme, showed improvements in activity and participation levels.

Aim: To gain insight, from the perspective of patients and therapists, into the critical ingredients of the programme, that contributed to improvements in activity and participation.

Materials and methods: A qualitative study using semi-structured interviews with eight patients and five therapists (three occupational therapists and two physical therapists). Participants were asked to identify and describe factors regarding the rehabilitation that they perceived as positive and aspects of the programme that could be improved. Data were analysed using a constant comparative approach.

Results: Patients reported (1) Time to diagnose: “Finally I’m in the right place;” (2) Awareness: “They gave me a mirror;” (3) Partnership: “There was real contact with the therapists; we made decisions together;” (4) Close collaboration: “Overlapping scopes of practice; doing the same from a different perspective;” and finally (5) Self-management: “Now I can do it myself.” Therapists reported (1) “Patients knowledge and understanding is critical to success;” (2) “Activate problem solving and decision making;” (3) “Personalize your therapy; it’s more than just giving exercises and information;” (4) “Constant consultation within the team; consistency in messages and approach;” and (5)” Ultimately the patient is in charge.”

Conclusions: The critical ingredients, correspond well with each other and include a person-centred approach, education, support in problem solving and decision making and an integrated team approach. These ingredients provided the patients with confidence to take responsibility to manage their everyday lives, the ultimate goal of the programme.

• Implications for rehabilitation

• Both patients and therapists believe that the ability to self-manage and take control should be the outcome of high quality integrated rehabilitation programmes for patients with neuralgic amyotrophy and/or other brachial plexus injuries.

• A person-centred, collaborative, and integrated team approach, among all members of the team, are critical components of care delivery in personalised interventions.

• Critical programme ingredients are knowledge and education of both the patient and therapists; partnership between patient–therapist and within the team; patient activation and self-reflection; and personalised care.

• Patients recommend more options for personalisation of the intensity and duration of rehabilitation, the possibility to consult a psychologist and peer support within a group setting.

     

臂丛神经损伤患者伤残接受度与创伤后应激反应的相关性研究

目的 探讨臂丛神经损伤患者的创伤后应激反应与伤残接受度的关系.方法 采用事件影响量表修订版(IES-R)、伤残接受度量表(ADS)和患者一般情况和损伤特征调查表,对160例臂丛神经损伤患者进行调查,并作相关分析.结果 臂丛神经损伤患者的伤残接受度属于中等程度,评分为(79.07±11.99)分.臂丛神经损伤患者普遍存在创伤后应激反应,IES-R总分为4-66(33.51±14.41)分,82.5%的调查对象IES-R总分>19分.伤残接受度与创伤后应激反应之间存在显著负相关,并具有统计学意义(r=-0.480,P=0.000).结论 护士应该重视患者的伤残接受度和创伤后应激反应,并根据患者的实际情况,给予有针对性的健康宣教和有效的心理干预措施等,以提高患者的心理健康水平和生活质量.     

The level and influencing factors of quality of life in patients with brachial plexus injury

PurposeTo investigate the overall quality of life level and identify influencing factors in patients with traumatic brachial plexus injury.MethodsOne hundred three patients with brachial plexus injury were assessed using the World Health Organization Quality of Life-BREF (WHOQOL-BREF) and Family Adaptability and Cohesion Evaluation Scale (FACESII-CV) questionnaires.ResultsThe overall quality of life score from patients with brachial plexus injury was 65.78 ± 15.2. The scores for the physical, psychological and environmental factors were significantly lower than the norm (Ps < 0.05). Regression analysis showed that age, injury located ipsilateral to the dominant hand, upper limb function score, score of family intimacy and family income were all factors influencing the of quality of life.ConclusionsA brachial plexus injury significantly compromises an individual's quality of life. Multiple factors influence this quality, which should be targeted to augment the physical and psychological care provided.     

桥小脑角手术致同侧臂丛神经损伤的原因分析及预防

桥小脑角(cerebellopontine angle,CPA)手术属于神经显微外科的一个分支.这类手术时间长,体位放置一般为90°侧卧位.按照手术体位放置的原则,巡问护士在摆放90°体位时,往往会特别注意勿使处于身体下方的手臂受压和过度伸展,以防臂丛神经损伤,而实际操作过程中,手术同侧颈肩部之间被过度牵拉和上臂不正确的放置,同样也会造成臂丛神经损伤.     

桥小脑角手术致同侧臂丛神经损伤的原因分析及预防

桥小脑角（cerebellopontine angle,CPA）手术属于神经显微外科的一个分支。这类手术时间长,体位放置一般为90°侧卧位。按照手术体位放置的原则．巡回护士在摆放90°体位时,往往会特别注意勿使处于身体下方的手臂受压和过度伸展,以防臂丛神经损伤,而实际操作过程中,手术同侧颈肩部之间被过度牵拉和上臂不正确的放置,同样也会造成臂丛神经损伤。我院神经外科于2008年4月1日施行1例CPA手术,术后造成病人臂丛神经损伤。现介绍如下。