促进屈肌腱滑动对手外伤患者僵硬手功能恢复的影响

目的:研究对手外伤手僵硬患者施行促进屈肌腱滑动的训练方案后,手功能恢复的情况.方法:30例手外伤所致手功能障碍患者随机分为观察组和对照组,对照组15例,32指,进行综合的康复治疗及作业治疗活动.观察组15例,34指,在综合康复治疗的基础上,进行促进屈肌腱滑动的训练方案.具体做法包括:关节定位训练,勾拳、握拳、直角握拳训练,屈浅肌腱的单独滑动训练,单独的掌指关节关节屈曲训练.疗程结束后采用CASRROLL手功能测试表测试手的整体功能,采用国际手外科学会推荐的总主活动度(TAM)对每个手指进行测定并统计优良率.结果:治疗后观察组和对照组间的CARROLL值经t检验,t=4.971,P＜0.05,差异有显著性意义,观察组优于对照组.而两组患者治疗后的TAM值,经t检验,t=3.45,P＜ 0.001,差异亦有显著性意义.观察组手指TAM的优良率为70.6％,无一例患者功能为差.对照组手指TAM的优良率为34.4％,有2例患者功能被评为差.优良率经秩和检验,Z=3.262,P＜0.001,差异有显著性意义.结论:对于手外伤后没有及时得到康复训练而手功能障碍的患者,在施行关节松动,物理治疗,作业治疗等康复治疗同时,也要注意屈肌腱滑动差的问题,应该促进肌腱的滑动,以取得更好的手功能恢复.     

手外伤术后的综合康复治疗

目的探讨手外伤术后进行综合康复治疗的疗效。方法应用多种物理因子结合作业治疗,对30例手外伤术后需进行康复治疗的患者进行综合康复训练。评价治疗前与治疗两疗程后患手普渡手精细运动（PPT）和总的主动活动度（TAM）。结果治疗两疗程后,患者患手、双手及组装运动能力明显提高（P〈0.05）,TAM也明显增加（P〈0.01）。临床疗效评定,优8例（26.7%）,良14例（46.7）,中6例（20.0%）,差2例（6.3%）,优良率为73.3%。结论早期正确的物理因子配合作业治疗能极大改善手外伤术后的功能障碍,使患者日...     

指屈肌腱修复术后早期功能锻炼对手功能恢复的影响

将60例指屈肌腱损伤患者分为治疗组及对照组，治疗组在手指屈肌腱修复术后第1天即使用支具情况下开始进行物理治疗及康复训练；对照组行常规治疗护理。术后3个月按TAM评定两组患指疗效，治疗组手指功能恢复优良率达96．7％，明显高于对照组。屈肌腱术后功能锻炼愈早，手功能恢复优良率愈高。     

手康复系列讲座（续二）

4.1 手康复治疗的目的:手康复治疗目的是恢复一个无痛性、全范围活动的手。一个伸直僵硬而不能届曲的手是毫无用处的。为了适应每天活动需要,首先．手应有抓握和对指功能．其次是手的伸直。很如手指屈曲活动受限,则可以增加掌指关节屈曲来补偿。一般情况下,手各部位功能的重要程度应该是,桡尺关节：旋前>旋后;腕关节：伸腕>屈腕;尺偏>桡偏;手指：依次是,掌指关节届曲、指间关节伸。     

中西医结合康复疗法对手外伤术后患者手功能恢复的影响

目的:探讨中西医结合康复疗法对手外伤术后患者手功能恢复的影响。方法:选取2011年1月~2015年1月于我院行手术治疗的手外伤患者58例为研究对象,采用抽签法随机分为对照组和研究组各29例。对照组术后应用常规康复训练,研究组在对照组基础上采取中医疗法。比较两组患者手指消肿时间及手功能恢复情况。结果:研究组患者手功能恢复优良率明显高于对照组,平均手指消肿时间低于对照组(P0.05)。结论:中西医结合康复疗法对手外伤术后患者手功能恢复有正性影响,临床应用价值较高。     

手康复系列讲座(续二)

４关节松动技术４．１手康复治疗的目的手康复治疗目的是恢复一个无痛性、全范围活动的手。一个伸直僵硬而不能屈曲的手是毫无用处的。为了适应每天活动需要，首先，手应有抓握和对指功能，其次是手的伸直。假如手指屈曲活动受限，则可以增加掌指关节屈曲来补偿。一般情况...     

早期系统康复治疗对手外伤术后患者的影响

目的：观察手外伤术后住院患者规范的早期综合康复治疗的临床疗效。方法：368例手部外伤术后患者在手外科常规治疗的基础上给予规范的早期主被动活动,中期主动运动及后期抗阻练习等,并配合相应的物理因子和支具治疗。治疗2及4个月时分别进行手关节总主动活动度（TAM）评定、明尼苏达手灵巧度（MMDT）、普渡手精细运动（PPT）及临床疗效评定。结果：与术后2个月时比较,治疗4个月后,368例患者MMDT评定时间明显缩短,PPT及TAM明显提高（均P〈0．05）;临床疗效显示,优良率91．3％。结论：规范早期综合康复治疗能预防手外伤术后患者的关节僵硬及肌腱粘连,显著提高手的运动功能。     

程式化近指间关节松解术结合系统康复治疗的疗效分析

目的:探讨程式化近指间关节松解术结合系统康复治疗近指间关节僵硬的临床疗效。方法:选取2014年3月~2017年3月我院收治的手外伤致近指间关节僵硬患者110例(指),随机分为对照组和实验组,每组55例(指),对照组采用系统康复治疗,实验组采用"系统康复-程式化关节松解术-系统康复"治疗模式,比较两组的近指间关节功能优良率与并发症发生率。结果:术后第1、2周,两组患者的近指间关节功能优良率相比较,差异无统计学意义,P>0.05;术后第4周开始,实验组的近指间关节功能优良率明显高于对照组,差异有统计学意义,P<0.05;两组治疗期间的不良事件发生率相比较,差异无统计学意义,P>0.05。结论:程式化近指间关节松解术结合系统康复可有效改善患者手指近指间关节活动功能,且安全可靠,临床效果显著。     

指屈肌腱修复术后早期功能锻炼对手功能恢复的影响

将60例指屈肌腱损伤患者分为治疗组及对照组,治疗组在手指屈肌腱修复术后第1天即使用支具情况下开始进行物理治疗及康复训练;对照组行常规治疗护理。术后3个月按TAM评定两组患指疗效,治疗组手指功能恢复优良率达96.7%,明显高于对照组。屈肌腱术后功能锻炼愈早,手功能恢复优良率愈高。     

个性化训练改善手指关节僵硬的作用

手部创伤后手指关节僵硬治疗不当可造成手的功能障碍或严重残疾。针对各种原因所致的手指关节僵硬采用不同的康复治疗方法，观察其疗效。     

Short-term effects of dynamic lycra splints on upper limb in hemiplegic patients

OBJECTIVE: To assess acceptability, effects on swelling, resting posture, spasticity, and active (AROM) and passive range of motion (PROM) of individually tailored upper limb Lycra garments, designed as dynamic splints to exert directional pull on certain limb segments, when worn for 3 hours by hemiplegic patients. DESIGN: Crossover trial. SETTING: Outpatient and inpatient rehabilitation center. PATIENTS: Convenience sample of 16 patients with hemiparesis and upper limb spasticity caused by a stroke more than 3 weeks before the study. INTERVENTIONS: Assessments performed at the start and end of a 3-hour period during a standard rehabilitation day when the patients were and were not wearing the garment. MAIN OUTCOME MEASURES: (1) Comfort assessed by questionnaire; (2) circumference of each limb segment; (3) resting posture at elbow and wrist; (4) spasticity at shoulder, elbow, and wrist using the Tardieu scale; and (5) AROM and PROM at shoulder, elbow, and wrist measured using a goniometer; (6) elbow proprioception using McCloskey's method; (7) visual neglect syndrome using the line bisection test. Differences between changes occurring with and without the garment were compared using Wilcoxon's signed rank test for ordinal variables (spasticity grading) and Student's t test for continuous variables (all other data). RESULTS: During 3 hours, garments worn on the arm by patients with hemiplegia (1) were comfortable, (2) improved wrist posture and reduced wrist and finger flexor spasticity, (3) reduced swelling in patients with swollen limbs (digit circumference decreased by 4%; p<.01), (4) improved PROM at shoulder (mean increase in range, 4.1 degrees +/- 13.0 degrees per shoulder movement; p<.01); and (5) impaired ability to flex fingers (range of voluntary flexion of digit III reduced from 107.3 degrees +/-79.6 degrees to 91.4 degrees +/-74.1 degrees; p<.05). CONCLUSION: Lycra garments, designed to produce continuous stretch of spastic muscles when worn for several hours each day, have rapid splinting and antispastic effects on wrist and fingers in patients with hemiplegia. These garments may help severely affected patients with major spasticity or painful swollen limbs.     

水中运动疗法配合中药熏蒸和冷疗治疗胫骨平台骨折术后膝关节功能障碍的效果观察

目的 探讨水中运动疗法配合下肢中药熏蒸、冷疗治疗胫骨平台骨折术后膝关节功能障碍的效果观察,为临床胫骨平台骨折术后康复方案的制定提供参考。方法 收集西安工会医院2018年2月至2021年1月收治的胫骨平台骨折术后康复患者病例,整理资料根据患者住院期间的治疗方式分为观察组和对照组。然后对照组和观察组均随机抽取28例纳入研究,共计56例。对照组采用徒手运动疗法配合蜡疗进行治疗,观察组采用水中运动配合下肢中药熏蒸、冷疗进行治疗;两组治疗均为1个月。应用标准量角器测量两组的膝关节主动活动度(AROM)和被动活动度(PROM),应用视觉模拟评分(VAS)评估膝关节最大被动活动疼痛程度。比较两组治疗前后的膝关节主、被动活动度,关节VAS评分,膝关节处肿胀程度以及日常生活活动能力(ADL)。结果 治疗1个月后两组患者膝关节症状主动、被动关节活动度、VAS评分、肿胀程度、ADL评分差异具有统计学意义(P <0.05),且观察组的膝关节AROM (120.71±8.99)°、PROM (126.96±8.95)°、VAS(2.14±0.89)分、肿胀值(0.28±0.46)cm、ADL (97.67...     

示指关节活动空间及其应用

目的 测量健康和受伤后示指关节活动空间,探讨其在康复中的应用价值。方法 招募示指未受过伤的健康大学生志愿者30例(健康组)和示指近期受伤的大学生志愿者3例(患者组),嘱其在示指独立以及与中指协同状态下做屈伸、内收、外展和环转运动,每个动作重复2次,间隔30 s。采用高清相机记录示指运动轨迹,MATLAB软件整理分析视频,比较两组不同动作的运动范围,绘制伤指运动空间和范围对比图。结果 与健康组相比,患者组示指独立屈伸及内收-外展范围分别缺失26.5%和24.6%。由于伤指恢复程度不同,3例患者环转运动缺陷个体差异较大,最大缺失方向分别在160°、70°和170°。结论 观察示指运动空间缺失范围百分比和最大缺陷方向,有助于对伤指的康复评定。     

Upper extremity strength and range of motion and their relationship to function in breast cancer survivors

The impact upper extremity impairments (UE) have on UE function in breast cancer survivors (BCS) is unclear. The purpose of this study was to evaluate the associations between upper extremity active range of motion (AROM), passive range of motion (PROM), and strength with self-reported function in BCS. BCS (n = 24) completed the Disabilities of Arm, Shoulder and Hand (DASH) and the Pennsylvania Shoulder Score (PSS). AROM and PROM of shoulder flexion, extension, external rotation (ER) at 0° and 90° of abduction, and internal rotation (IR) at 90° of abduction were measured using a digital inclinometer. Strength was measured using a hand-held dynamometer for scapular abduction and upward rotation, scapular depression and adduction, flexion, IR, ER, scaption, and horizontal adduction. All constructs of AROM, PROM, and strength were correlated with the DASH and PSS. DASH was moderately to highly correlated with 2 of 5 AROM, 2 of 5 PROM, and 6 of 7 shoulder strength measures. PSS was moderately to highly correlated with 2 of 5 AROM, 2 of 5 PROM, and 4 of 7 shoulder strength measures. Regression analysis showed that AROM explained 40% of the DASH scores and strength explained 20% of scores on the PSS. This study characterizes the impact that shoulder motion, flexibility, and strength losses have on shoulder function in BCS. Deficits in AROM and shoulder strength explained the greatest proportion of shoulder disability. Future clinical trials should consider incorporating AROM and strengthening techniques to improve shoulder use after breast cancer treatments.     

Rehabilitation of fingers after flexor tendon lesions qualified for secondary reconstruction, using Kleinert's dynamic splinting method

Background. Primary reconstruction of flexor tendons lesions resulting from serious hand mutilations is not always possible. This causes problems in the rehabilitation of finger joints that are unable to perform active flexion. There is no generally accepted approach to such cases. The authors used a dynamic splinting regimen to treat fingers with unrepaired flexor tendons qualified for secondary reconstruction. Material and methods. Our research involved 39 patients treated in the Department Limb Replantation at St. Jadwiga's Hospital in Trzebnica, Poland, who had been referred for flexor tendon repair (from 1 to 3) in secondary reconstruction. The time from the primary operation ranged from 10 to 14 weeks. There were 27 men and 12 women, ranging in age from 19 to 60 years (ave. 39.5), divided into two groups. 24 patients (group I) had their fingers mobilized by dynamic splinting method, while in 14 patients (group II) no specific regimen of rehabilitation applied: the patients mobilized their fingers with their unimpaired hand. Results. The loss of total passive motion of finger joints was up to 75.65 degrees (~29%) greater in group II. Conclusions. The method applied is very effective in maintaining a wide range of passive motion in finger joints, which is essential for secondary flexor tendon reconstruction.     

手外伤术后关节活动能力与功能的相关性

摘要 目的：研究手外伤术后患者手部关节活动能力与手功能恢复的相关性。 方法：对2012年11月—2013年3月我院32例手外伤术后康复患者,评估拇指对指功能评分、前臂旋转角度、腕关节活动度和手指关节总主动活动度（TAM）。采用Jebsen手功能测试量表评定手功能,进行直线相关分析和多元线性逐步回归分析。 结果：拇指对指功能评分与写字、叠棋子和捡小物时间呈负相关性。拇指TAM与翻纸牌和拿大的重罐子时间呈负相关性。前臂旋前角度与拿大的轻罐子时间呈负相关性。 结论：拇指对指功能评分、拇指TAM是影响测试的关键因素。术后康复应以恢复对指功能和拇指活动度为重点。术后固定时,应尽量开放无损伤部位,维持拇指活动度和对指功能。     

运动反馈训练对偏瘫患者上肢运动功能和日常生活活动能力的疗效

目的 探讨了Armeo Spring上肢运动反馈训练对偏瘫患者上肢运动功能和日常生活活动能力的疗效。 方法 52例偏瘫患者随机数字表法分为观察组和对照组,各26例。对照组进行常规康复训练的基础上增加每日1次作业疗法训练,观察组在常规康复训练的基础上增加每日1次Armeo Spring上肢运动反馈的作业疗法训练,2组治疗时间均为5个月,治疗前和治疗后分别对2组患者上肢和手的主动关节活动度测量（AROM）、改良Barthel 指数(Modify Barthel Index,MBI)、Fugl-Meyer 评定量表(Fugl-Meyer motor assessment scale,FMA）和简易上肢机能检查（Simple Test for Evaluating hand Function,STEF）进行评价。 结果 治疗前2组患者MBI、FMA和WMFT比较差异无统计学意义（P＞0.05）;治疗后2组患者MBI、FMA和WMFT较治疗前比较差异有统计学意义（P＜0.05）,观察组MBI、FMA和WMFT较对照组差异均有显著统计学意义（P<0.05）,且观察组各项指标改善均优于对照组。 结论 通过上肢运动反馈训练联合常规康复可明显改善偏瘫患者上肢运动功能和日常生活活动能力。     

静态渐进性牵伸技术联合肌肉能量技术在创伤后肘关节僵硬康复治疗中的应用

目的:观察静态渐进性牵伸技术(SPS)联合肌肉能量技术(MET)对创伤后肘关节僵硬康复的影响。方法:将符合纳入标准的创伤后肘关节僵硬患者78例按照随机数字表法分为对照组和观察组各39例,2组均接受常规康复疗法,包括运动治疗、关节松动术、物理因子治疗、中药熏洗、作业治疗,对照组在常规治疗基础上仅给予SPS治疗,研究组在常规治疗基础上给予SPS技术和MET联合治疗。2组治疗前后进行肘关节AROM,视觉模拟评分法(VAS),HSS肘关节功能评分,改良Bathel指数(MBI),一般自我效能感量表(GSES)对患者治疗前后肘关节功能进行评价。结果:治疗前,2组患者AROM、VAS、HHS、MBI及GSES评分组间比较差异均无统计学意义。治疗4周后,2组患者肘关节AROM和HHS评分均较治疗前明显提高(均P<0.01),且观察组明显高于对照组(均P<0.05);2组患者肘关节VAS评分均较治疗前明显降低(P<0.01),且观察组明显低于对照组(P<0.05)。治疗后,2组患者MBI评分均较治疗前明显提高(P<0.01),但2组间比较差异无统计学意义;治疗4周后,2组患者GSES评分均较治疗前明显提高(P<0.01),且观察组明显高于对照组(P<0.05)。结论:MET联合SPS治疗能更好的改善肘关节的功能障碍,尤其是在缓解疼痛和改善肘关节主动活动度方面具有明显的效果,同时有助于提高患者自我效能感。     

断指再植与功能康复一体化的护理

目的：探讨断指再植功能康复护理的最佳方法。方法：将指再植的术前护理、术中配合和术后康复护理形成一体化，对428例(指)断指再植患者进行系统康复护理，全部病例均在术后6—18个月内随访。并按中野方法测评患侧功能恢复情况。结果：优52例(指)，良3ll例(指)，可40例(指)，优良率85％。结论：断指再植与功能康复一体化护理计划，将断指再植的每个康复过程都紧密联系在一起，使患者得到不间断的康复与护理治疗。     

The effectiveness of functional electrical stimulation for the treatment of shoulder subluxation and shoulder pain in hemiplegic patients: A randomized controlled trial

Purpose.?To investigate the effect of functional electrical stimulation (FES) for the treatment of shoulder subluxation and shoulder pain in hemiplegic patients.

Method.?A total of 50 hemiplegic patients with shoulder subluxation and shoulder pain were included in the study. The patients were randomly divided into the study and control groups. All patients were put on a rehabilitation program using conventional methods while the study group patients were additionally applied FES to supraspinatus and posterior deltoid muscles. The shoulder pain of all patients during resting, passive range of motion (PROM) and active range of motion (AROM) was measured with the visual analog scale (VAS) while the shoulder subluxation levels were evaluated with the classification developed by Van Langenberghe and by using the millimetric measurements on anteroposterior shoulder X-ray before and after the physical treatment and rehabilitation program and compared.

Results.?Comparison of the resting AROM vs. PROM VAS value changes showed no significant difference between the groups. There was a significant difference between the two groups for the amount of change in shoulder subluxation in favor of the study group.

Conclusions.?The results of our study have shown that applying FES treatment to the supraspinatus and posterior deltoid muscles in addition to conventional treatment when treating the subluxation in hemiplegic patients is more beneficial than conventional treatment by itself.