系列矫形支具在烧伤后手功能恢复中的应用

目的 了解自制静态和动态手支具对烧伤后手功能恢复的作用.方法 在烧伤后不同治疗阶段,为32例患者的52只手制作不同类型支具,针对不同个体单独或联合使用,采用Car-roll上肢功能评定标准,对上肢及手的整体功能(包括粗动作及精细动作如抓、握、捏、夹及手臂旋前、旋后、取物、放置等)进行定量评定,比较使用支具治疗前后手部功能恢复情况.结果 按Carroll上肢功能评定标准.治疗前患手功能Ⅳ级7只、Ⅲ级15只、Ⅱ级23只、Ⅰ级7只.治疗3个月后重新评定.手功能Ⅵ级9只、Ⅴ级28只、Ⅳ级9只、Ⅲ级6只.28例患者46只手的对指、对掌、握、捏等功能恢复较好,可完成日常生活中的手部活动.结论 该自制手支具对预防和治疗手烧伤后瘢痕挛缩有良好的效果,可明显促进手功能的恢复.     

超早期康复护理防治偏瘫患者肩手综合征效果观察

目的观察超早期康复护理对预防和治疗脑卒中偏瘫患者肩手综合征的作用.方法将238例脑卒中偏瘫患者随机分为康复组(122例)和对照组116例),两组均给予常规药物治疗和护理,康复组在此基础上予超早期康复护理,包括保持功能和做医疗体操和向心性缠绕压迫手指法、冷-温水交替浸泡法、上举患侧上肢、利用意念促使肢体功能恢复等多种康复训练措施.最后根据患者手指肿胀发生率、患手指肿胀程度以及简易手功能检查(STEE)评定康复效果.结果康复组患者肩手综合征发生率显著低于对照组(P<0.01);康复组治疗后较治疗前手指肿胀程度显著减轻(P<0.01);两组治疗后患肢运动功能均较前显著恢复(P<0.05,P<0.01),而康复组更显著(P<0.05).结论超早期康复护理对脑卒中偏瘫患者肩手综合征的预防和治疗具有积极的促进作用.     

烧伤后爪形手畸形的整复

目的 探讨烧伤后爪形手畸形的整复方法. 方法 1992年5月-2007年5月,笔者对97例(136只患手)烧伤后爪形手畸形患者进行手术整复,患手中,轻度畸形21只、中度92只、重度23只;手背创面植皮修复104只患手,皮瓣转移修复32只患手.掌指关节复位在手背部瘢痕组织充分松解后主要采用手法拔伸牵引复位,必要时松解侧副韧带、背侧关节囊和分离关节内粘连,肌腱挛缩明显者行肌腱延长术.手背瘢痕松解整复后根据情况行手指屈曲畸形整复、指蹼和虎口粘连松解植皮、指伸肌腱中央腱修复或指间关节融合术.31例患者因手指屈曲畸形严重,阻碍掌指关节复位,先行手指掌侧瘢痕松解植皮,再行手背瘢痕松解、掌指关节复位、皮瓣转移或植皮.术后采取综合康复治疗措施. 结果术后皮片全部成活;4只患手皮瓣远端边缘因瘢痕组织部分坏死,换药后愈合,其余皮瓣完全成活.患手绝大部分关节畸形完全或基本纠正,对掌、握拳功能恢复或部分恢复,效果较为满意. 结论个性化、系统全面地进行皮片移植和皮瓣转移是整复烧伤后爪形手的关键.     

儿童手烧伤后瘢痕挛缩家庭康复治疗模式的探索

目的探索儿童手烧伤后瘢痕挛缩的家庭康复治疗模式并观察其疗效。方法采用回顾性非随机对照研究方法。2020年3月—2021年3月, 空军军医大学第一附属医院全军烧伤中心收治30例符合入选标准的手深Ⅱ或Ⅲ度烧伤后瘢痕挛缩患儿。根据采取的康复治疗模式, 将18例患儿(23只患手)纳入家庭康复治疗为主组(以下简称家庭康复组)、12例患儿(15只患手)纳入医院康复治疗为主组(以下简称医院康复组), 前组患儿中男11例、女7例, 年龄(4.8±2.1)岁, 创面愈合后(3.1±0.8)d开始康复治疗;后组患儿中男7例、女5例, 年龄(4.6±2.1)岁, 创面愈合后(2.8±0.7)d开始康复治疗。医院康复组患儿以在院主被动康复训练为主, 辅以回家后自主康复训练;家庭康复组患儿接受在院主被动康复训练1～2周后, 在家通过微信平台接受康复治疗师指导进行主被动康复训练。2组患儿均治疗6个月, 治疗期间均佩戴压力手套并联合使用手屈曲训练带和分指支具。治疗前及治疗6个月后, 分别采用改良温哥华瘢痕量表、手总主动活动度法和Carroll上肢功能评定法对患手瘢痕(计算治疗前后瘢痕评分差值)、关节活动度(计算优良...     

应用King达标理论提高手烧伤患者术后康复治疗依从性的研究

目的:探讨在手部烧伤患者中运用King互动达标理论的相关概念和方法,使护患双方达到认识的统一和良好的交流,提高术后功能锻炼与康复治疗的依从性,促进身心健康。方法:选择80例深度手烧伤患者随机分为对照组和干预组各40例。两组患者入院后对照组给予常规护理,干预组运用King互动达标理论为指导进行护理,比较两组患者对康复治疗的依从性和功能恢复情况。结果:干预组患者术后康复治疗依从性明显高于对照组,功能的恢复也优于对照组,组间比较差异具有统计学意义。结论:运用King达标理论对手烧伤患者进行护理可显著提高患者的康复治疗依从性,促进功能恢复,值得临床推广应用。     

分指握球套在去皮质综合征患儿手功能康复中的应用

目的 探讨分指握球套在去皮质综合征患儿手功能康复中的应用效果.方法 以病房中线为界,以抽签形式将病区左右两侧进行分组,将去皮质综合征患几分别纳入观察组和对照组各40例.对照组给予常规药物治疗和康复治疗,观察组在对照组基础上佩戴分指握球套.治疗前,治疗2周、4周后采用Lindmark手功能评定量表、Fugl-Meyer评分量表上肢部分评估干预效果,并观察患儿住院期间皮肤损伤及红肿发生率.结果 观察组38例,对照组39例完成研究纳入分析.治疗后2周、4周,观察组手功能、上肢运动功能评分显著高于对照组(均P＜0.01).干预后观察组皮肤损伤及红肿发生率显著低于对照组(均P＜0.01).结论 早期佩戴分指握球套联合康复治疗有利于去皮质综合征患儿手部功能恢复,降低手部皮肤损伤及红肿发生率.     

手部烧伤后瘢痕的综合治疗

目的 探讨手部烧伤后瘢痕增生的治疗方法.方法 对2007～2011年收治的手部烧伤后瘢痕增生患者46例78只手,采用瘢痕切除皮片移植、挛缩松解、克氏针固定38只手,瘢痕切除局部皮瓣转移18只手,瘢痕切除植皮18只手,瘢痕切除腹部远位扩张皮瓣转移4只手,术区半年内均给予弹力套加压疗法、外用硅凝胶制剂及功能训练治疗,52只手部切口给予蜡疗药物导入治疗,26只手部切口有瘢痕增生,给予瘢痕内药物注射治疗,治疗结束后随访0.5～3年,观察患手外观及功能恢复情况.结果 采用以手术治疗为主,术后配合弹力套加压疗法、外用硅凝胶制剂、瘢痕内药物注射治疗、蜡疗药物导入及功能训练等综合治疗措施,因瘢痕挛缩制约关节功能得到完全或大部分恢复,外观满意.结论 手术配合术后物理康复综合治疗,是手部瘢痕治疗的较好方法,值得推广应用.     

综合护理干预在手烧伤后功能与外形恢复中的应用

目的：对手烧伤的患者采用综合护理干预,使其在功能、心理及外形等方面均能得到全面的恢复。方法：对手烧伤患者住院期间实施围手术期创面护理、系统专业的康复护理、健康教育、各阶段的心理护理以及出院后的随访干预。结果：本组病例70例共78只手,实施综合护理干预后68例75只手的功能和外形恢复良好,无关节挛缩畸形,2例3只全手烧伤的患儿出现了爪形手姿势,经再次手术后得到修复。结论：实施综合护理干预使手烧伤患者功能、心理及外观得到了全面恢复,预防和减轻了畸形的发生。     

mu趾甲皮瓣移植再造拇指术式的改进及其展望

拇指能作外展、对掌、持、捏等动作，约占手功能的40％，一旦缺损，将严重影响患者的日常生活和工作。因此，拇指伤残后，如何再造以恢复功能，一直以来是手外科的重要课题。     

康复疗法联合强肌增活训练在手部烧伤整形术患者中的应用效果

分析在手部烧伤患者整形术后给予康复疗法联合强肌增活训练的效果。方法 选取2022年 1月-2023年1月于我院接受整形术治疗的130例手部烧伤患者为研究对象，随机分为对照组和观察组，每组 65例。对照组接受常规干预，观察组接受康复疗法联合强肌增活训练，比较两组手功能恢复情况、关节活 动度及日常生活能力。结果 观察组手功能总恢复率为98.46%，高于对照组的76.92%（P ＜0.05）；观察组 干预后T AM及C a r r o l l手功能测试评分均高于对照组（P ＜0 . 0 5）；观察组A D L评分高于对照组 （P ＜0.05）。结论 针对手部烧伤整形术患者给予康复疗法联合强肌增活训练的效果良好，可有效促进手 功能恢复，有利于改善患者的关节活动度，提高其日常生活能力。     

The burned hand. A computer-assisted study of late function of 67 burned and operated hands

A good functional outcome of the hand is important in the rehabilitation of severely burned patients. The aim of the study was to evaluate the late functional outcome of deeply burned hands using a computer aided system and to correlate the function with the distribution of the hand burns. Over a 12-year-period 378 patients whose acutely burned hands had been operated on at the burn center of the university hospital Aachen were invited to a follow-up examination. 67 burned and operated hands were evaluated 57 (3-364) months after the burn by the computerized evaluation system EVAL. Active flexion and extension, grip strength, pinch (key, 3-tip and 2-tip), moving 2-point sensitivity and the pattern of skin grafts and scars were assessed. The use of the hand in daily activities was evaluated by a questionnaire. The hands were classified in 4 groups according to the burn pattern: I: patchy burns (total < 12 cm2), II: confluent dorsal burns, III: confluent palmar burns, IV: mutilating burns. Good results were found in group I (n = 25), comparable to normal hand function. In group II (n = 25) there was a significant loss of total active flexion with preserved strength. Increased extension lag and impaired grip strength characterized group III (n = 8). Late functional results in group IV (n = 9) depended on the reconstructive procedure. Between the 4 groups there were significant differences in function. The results were well correlated to the burn pattern and its extent according the classification.     

Comparison of therapeutic activities with therapeutic exercises in the rehabilitation of young adult patients with hand injuries

PURPOSE: To compare the efficacy of therapeutic activities that mimick the activities of daily living with that of traditionally used therapeutic exercises in the management of injured hands in young adult patients. METHODS: Thirty-six patients having functional loss due to hand injury were enrolled. Patients were allocated randomly into 2 groups. The study group included 20 patients, and the control group included 16 patients. For the control group, according to their impairments, an exercise program including passive, active assistive, and active range of motion and strengthening exercises in addition to physical modalities was applied for 2 sessions a day. For the study group, in addition to 1 session of the same program, a program composed of 25 activities that mimick activities of daily living (ADL) was applied for 1 session. Treatment continued for 3 weeks, 5 days a week. Then the patients were given a home program. After 2 months, patients were reevaluated. RESULTS: Mean age for the patients was 23 years +/- 3. The time span from injury to surgery was a mean of 7 days +/- 5, and the mean period between the injury and the physical therapy was a mean of 102 days +/- 68. Grip strength, pinch strength, finger pulp-distal palmar crease distance, total active movement, range of opposition, range of abduction, Jebsen hand function test, and Disabilities of Arm, Shoulder, and Hand scores were obtained before treatment, after treatment, and 2 months after treatment. At final assessment, differences in improvements of all parameters were found to be statistically significant between the groups in favor of the study group. CONCLUSIONS: Because of the complex anatomy, determination of the most appropriate treatment may not be easy in an injured hand. Our results showed that the therapeutic activities that mimick the ADL improve the functions of the hand more effectively. We suggest that the therapeutic activities that mimick the ADL may be more beneficial than the standard rehabilitation activities in the management of an injured hand.     

康复疗法联合强肌增活训练在手部烧伤整形术患者中的应用效果

观察康复疗法联合强肌增活训练在手部烧伤整形术患者中的应用效果。方法 选择2021年 1月-2022年1月来我院接受治疗的手部烧伤整形术患者100例，随机分为对照组和观察组，每组50例。对照 组给予序贯压力康复疗法，观察组在对照组基础上联合强肌增活训练，比较两组手部功能、生活质量及干 预满意度。结果 两组干预后Carroll评分高于干预前，且观察组Carroll评分高于对照组，差异有统计学意义 （P＜0.05）；观察组日常生活能力优于对照组，差异有统计学意义（P＜0.05）；观察组满意度为92.00%， 高于对照组的86.00%，差异有统计学意义（P ＜0.05）。结论 康复疗法联合强肌增活训练可促进手部烧伤 整形术患者手部功能恢复，改善其日常生活能力，且患者对康复满意度较高。     

采用人工真皮修复大面积烧伤早期手部创面的疗效观察

目的:观察早期应用人工真皮修复大面积烧伤患者手部创面的效果.方法:选取2009年1月-2010年9月就诊于北京市右安门医院的大面积烧伤患者38例,采用随机分组方法分为两组.人工真皮组19例在早期修复手部创面手术中用人工真皮覆盖创面,2周后用自体刃厚皮片覆盖.对照组19例创面早期切痂、行自体微粒+异体皮移植,后期肉芽组织...     

两例异体移植手功能康复早期报告

目的 报告2周异体移植手早期功能康复结果。方法 2例心理和一般情况良好的右手外伤性缺如患者,通过组织配型后2例与其相匹配、无传染病脑死亡供者的异体手,移植方法 基本同断肢再植。术后密切观察生命体征、移植手血液循环和监测免疫排斥反应。术后进行心理治疗并在康复医师指导下进行功能锻炼。结果 Tinel征检查显示神经生长速度较快。术后4个月,移植手可以持物,痛、温觉试验和Tinel征检查显示,神经已生长至拇指、示指和小指末节及中指、环指远侧批间关节。术后5个月,例1移植 手指拇、小指有外展动作。术后6个月,例1拇指、小指外展动作增强且可抗阻力,能写定;例2移植手拇指、小指亦有外展动作。术后7个月,两患者尺、 桡骨愈合良好,去除内固定 物并 同时行肌腱和神经松解。术后8个月,移植手功能进一步加强,可以打羽毛球、拍篮球。术后9个月可以切菜。术后10个月,例1 手指运动功能恢复等级为良,正中神经优,尺神经良;例2手指运动功能恢复等级为良,正中神经与尺神经均为可。结论 移植手近期功能与自体断肢再植相似。为了提高异体移植手的功能,术前应严格筛选病例,受、供体 组织配要匹配,并制定合理的手术方案;术中操作精确、熟练;术后合理应用免疫抑制剂,同时配合实施良好的康复措施,对促进异 体移植手的功能康复具有重要意义。     

Burns of the upper extremity in children: long-term evaluation of function following treatment

Hand burns in children represent a severe and possibly deforming injury. This study evaluated 82 patients for type of burn, prognostic indicators, and treatment as it affected function and appearance. The best long-term results were associated with small palmar contact burns, compression garments, early skin grafting except for the palm, and late surgical release of webbing. Range of motion of the joints in the hand and clinical function were related. However, hand appearance had no correlation to clinical function. Various combinations of infection requiring intravenous antibiotics, skeletal suspension failure, fourth-degree burns, and/or nerve damage were associated with poor results.