带蒂皮瓣移植修复手术诱发冻结肩的预防和治疗研究

目的 探讨手、腕部或前臂皮肤缺损进行腹部皮瓣(带蒂)修复术时诱发冻结肩的预防和治疗.方法 选择手、腕部或前臂腹部皮瓣断蒂术患者60例,分为研究组和对照组,每组30例.研究组患者采用臂丛神经阻滞(肌间沟入路)+硬腰联合麻醉,腹部皮瓣断蒂术时兼顾对肩关节进行被动手法松解治疗和术后主动肩关节功能锻炼.对照组患者采用局麻或臂丛神经阻滞(肌间沟入路)+硬腰联合麻醉进行腹部皮瓣断蒂术.术后两组患者均进行患者静脉自控镇痛.断蒂术后2周对两组患者肩关节疼痛、Constant肩关节功能评分及肩关节活动度进行临床评估.结果 术后2周,研究组患者Constant肩关节功能评分高于对照组(P＜0.01),研究组患者肩关节疼痛及活动功能的改善情况显著优于对照组(P＜0.05),研究组患者临床治愈率、显效率明显优于对照组(P＜0.05),研究组患者麻醉效果优于对照组.结论 利用术中臂丛阻滞(肌间沟入路)复合硬腰联合麻醉提供的无痛及肌松条件,行肩关节的手法松解并且于术后配合主动的肩关节功能锻炼,能够预防和治疗带蒂皮瓣修复术后继发冻结肩,促进手及肩关节功能全面恢复,减轻术后痛苦,提高患者的生活质量.

Prevention and treatment of frozen shoulder induced by abdominal pedicle flaps transplantation

Objective To discuss the prevention and treatment of frozen shoulder induced by abdominal pedicle flaps transplantation to repair the skin defect of the hand,wrist or forearm.Methods Sixty patients admitted in our center undergoing elective abdominal pedicle flaps transplantation for skin defect were enrolled in this study.They were prospectively divided into the observation group and control group B,with 30 cases in each group.The patients in the observation group were treated with brachial plexus block (interscalene approach) and intraspinal anesthesia.When the pedicle of the abdominal flap was broken,the shoulder joint was treated with passive manipulation under anaesthesia and active shoulder joint function exercise after the operation.The patients in the control group were treated with local anesthesia or brachial plexus block (interscalene approach) and intraspinal anesthesia when the pedicle of the abdominal flap was broken.All patients in the 2 groups received patient-controlled intravenous analgesia (PCIA) postoperatively.In 2 weeks after surgery,the pains,range of motion (ROM) of shoulder joint and the score of Constant were evaluated to assess the function of the shoulder in both groups.Results In 2 weeks after operation,the Constant score was significantly higher in the observation group than the control group (P ＜ 0.01).The former group had better pain relief and ROM of shoulder joint (P ＜ 0.05),higher cure rate and effective rate (P ＜ 0.05),and better anesthetic effect when compared with the latter group.Conclusion When the pedicle of the abdominal flap is broken,we should give consideration to the prevention and treatment of frozen shoulder caused by operation,which can promote the full recovery of hand and shoulder joint function,relieve postoperative pain and improve the quality of life in the patients.