烧伤后手指瘢痕挛缩畸形综合治疗的临床研究

目的通过比较手术结合康复综合治疗方案与常规治疗方案对烧伤后手指瘢痕挛缩畸形的治疗效果,探讨综合治疗的优越性及经验。方法1999年6月~2004年6月,共56例烧伤后手指瘢痕挛缩畸形患者纳入试验。综合治疗组(A组)28例,男20例,女8例;年龄14~47岁,平均31岁;患手共47只129指,以手术结合系统康复治疗。常规治疗组(B组)28例,男17例,女11例;年龄18~51岁,平均30岁;患手共42只107指,采用常规手术,术后仅作简单的康复性锻炼指导,由患者在院外自己完成功能锻炼。采用Swanson法对患指运动功能进行评定,九孔柱试验法对患手整体运动功能进行评定,比较两组患者治疗前后手指和手整体运动功能的差异。结果A组患者术后均获随访12~19个月,B组患者均获随访13~20个月。治疗前A组患指的强直失能指数(indexofankylosis,IA)值为82%±20%,B组为78%±17%;治疗后A组为45%±13%,B组为52%±14%;治疗前后A组IA差值为37%±15%,B组为26%±15%,两组比较差异有统计学意义(P<0.05)。治疗前A组九孔柱测量值28.34±5.62s,B组为27.47±5.78s;治疗后A组为20.73±4.25s,B组为21.86±4.12s;治疗前后A组九孔柱测量差值为7.61±2.27s,B组为5.61±2.94s,两组比较差异有统计学意义(P<0.05)。结论烧伤后手指瘢痕挛缩畸形采用手术结合康复综合治疗的效果明显优于常规治疗,值得推广。

CLINICAL INVESTIGATION OF THE COMBINED THERAPY ON DEFORMED FINGERS AFTER BURN INJURY

OBJECTIVE: To investigate the benefit of the combined therapy for deformed fingers after burn injury by compairing with the conventional one, and to sum up some experience. METHODS: From June 1999 to June 2004, 56 patients with deformed fingers entered the trial. In 28 patients of treatment group who received combined therapy (operation with postoperational systematic convalescent care, group A), there were 20 males and 8 females (14-47 years), 129 fingers of 47 hands were involved. In 28 of conventional group who received conventional therapy (the same operational principle, and self-convalescent-care with out-patient service guidance, group B), there were 17 males and 11 femals (18-51 years), 107 fingers of 42 hands were involved. Before and after the therapy, the finger's motor function were assessed according to the Swanson method. The hand's motor function was assessed through the Nine Hole Peg Test. RESULTS: The follow-up was 12-19 months in group A and 13-20 months in group B. The index of ankylosis (IA) of group A before therapy was 82% +/- 20%, and 45% +/- 13% after theraphy; while the IA of group B before therapy was 78% +/- 17%, and 52% +/- 14% after therapy. The decreased of IA between before therapy and after therapy was 37% +/- 15% in group A, and 26% +/- 15% in group B, showing significant difference between the two groups (P<0.05). The Nine Hole Peg Test value of group A was 28.34 +/- 5.62 s before therapy, and 20.73 +/- 4.25 s after therapy; while that of group B was 27.47 +/- 5.78 s before therapy, and 21.86 +/- 4.12 s after therapy. The decrease of the Nine Hole Peg Test value between before therapy and after therapy was 7.61 +/- 2.27 s in group A, and 5.61 +/- 2.94 s in group B, showing statistically significant difference (P<0.05). CONCLUSION: The combined therapy is more effective than the conventional one.