Effects of hand continuous passive motion system combined with functional training and pressure gloves in treating early scar contracture after burn on the back of the hand
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摘要:
目的 观察手持续被动运动（CPM）系统联合功能训练与压力手套治疗手背部烧伤后早期瘢痕挛缩的效果。 方法 2017年6月—2019年12月，空军军医大学第一附属医院收治43例符合入选标准的手背部深Ⅱ~Ⅲ度烧伤后瘢痕挛缩患者，对其进行回顾性队列研究。根据采用的治疗方法，13例患者纳入单纯压力手套组［男9例、女4例，年龄（31±6）岁］，14例患者纳入压力手套+功能训练组［男11例、女3例，年龄（30±5）岁］，16例患者纳入压力手套+功能训练+CPM系统组［男10例、女6例，年龄（29±5）岁］。3组患者均行手背部植皮术，创面愈合后6~8 d开始进行相应康复治疗，均持续治疗3个月。治疗前及治疗3个月后，采用总主动活动度法评定手关节活动度并计算优良比例，采用Carroll上肢功能评定法评定上肢功能评分并计算治疗前后差值，采用温哥华瘢痕量表评定瘢痕评分并计算治疗前后差值。对数据行
χ 2检验、Fisher确切概率法检验、McNemar确切概率法检验、单因素方差分析、LSD检验、Bonferroni校正、Kruskal-Wallis检验、配对样本
t 检验。 结果 单纯压力手套组、压力手套+功能训练组、压力手套+功能训练+CPM系统组患者手关节活动度优良比例治疗前分别为2/13、2/14、3/16，治疗3个月后分别为4/13、6/14、14/16。治疗3个月后，压力手套+功能训练+CPM系统组患者手关节活动度优良比例显著高于另外2组（
P <0.05或
P <0.01）。与治疗前比较，仅压力手套+功能训练+CPM系统组患者治疗3个月后手关节活动度优良比例显著升高（
P <0.01）。治疗前，3组患者上肢功能评分、手瘢痕评分均相近（
F =0.598、0.035，
P >0.05）。治疗3个月后，压力手套+功能训练+CPM系统组患者上肢功能评分明显高于单纯压力手套组（
P <0.05）；压力手套+功能训练组、压力手套+功能训练+CPM系统组患者手瘢痕评分明显低于单纯压力手套组（
P <0.05或
P <0.01），压力手套+功能训练+CPM系统组患者手瘢痕评分明显低于压力手套+功能训练组（
P <0.05）。与治疗前比较，单纯压力手套组、压力手套+功能训练组、压力手套+功能训练+CPM系统组患者治疗3个月后上肢功能评分均明显升高（
t =-5.295、-7.252、-15.342，
P <0.01），手瘢痕评分均明显降低（
t =13.361、16.982、40.334，
P <0.01）。压力手套+功能训练+CPM系统组患者治疗前后上肢功能评分差值、手瘢痕评分差值均明显高于压力手套+功能训练组、单纯压力手套组（
P <0.05或
P <0.01），压力手套+功能训练组患者治疗前后上肢功能评分差值、手瘢痕评分差值均明显高于单纯压力手套组（
P <0.05）。 结论 手CPM系统联合功能训练与压力手套治疗手背部烧伤后早期瘢痕挛缩可显著改善手关节活动度，能较好地恢复手功能并改善手瘢痕情况，其效果优于功能训练等常规康复治疗，值得临床借鉴。
Abstract:Objective To observe the effects of hand continuous passive motion (CPM) system combined with functional training and pressure gloves in treating early scar contracture after burn on the back of the hand. Methods A retrospective cohort study was conducted in 43 patients who met the inclusion criteria and were admitted to the First Affiliated Hospital of Air Force Medical University from June 2017 to December 2019 with scar contracture after deep partial-thickness to full-thickness burn on the back of the hand. According to the treatment methods applied, 13 patients were enrolled into pressure glove alone group (9 males and 4 females, aged (31±6) years), 14 patients were enrolled into pressure glove+functional training group (11 males and 3 females, aged (30±5) years), and 16 patients were enrolled into pressure glove+functional training+CPM system group (10 males and 6 females, aged (29±5) years). All the patients in the three groups received skin grafting on the back of the hand. The corresponding rehabilitation treatment was started 6-8 days after wound healing, and the treatment lasted for 3 months. Before treatment and after 3 months of treatment, the total active motion range of the hand was measured to evaluate the motion range of the hand joint and the ratio of excellent and good was calculated; the Carroll upper limb function evaluation method was used to evaluate the upper limb function score, and the difference before and after treatment was calculated; the Vancouver Scar Scale was used to evaluate the scar score, and the difference before and after treatment was calculated. Data were statistically analyzed with chi-square test, Fisher's exact probability test, McNemar's exact probability test, one-way analysis of variance, Bonferroni correction, least significant difference test, Kruskal-Wallis test, and paired sample
t test. Results The ratio of excellent and good of the motion range of the hand joint of patients in pressure glove alone group, pressure glove+functional training group, and pressure glove+functional training+CPM system group were 2/13, 2/14, and 3/16 respectively before treatment, and 4/13, 6/14, and 14/16 respectively after 3 months of treatment. The ratio of excellent and good of the motion range of the hand joint of patients was significantly higher in pressure glove+functional training+CPM system group than in the other two groups after 3 months of treatment (
P <0.05 or
P <0.01). Compared with that before treatment, the ratio of excellent and good of the motion range of the hand joint of patients in pressure glove+functional training+CPM system group was significantly increased after 3 months of treatment (
P <0.01). Before treatment, the upper limb function score and hand scar score of patients in the three groups were similar (
F =0.598, 0.035,
P >0.05). After 3 months of treatment, the upper limb function score of patients was significantly higher in pressure glove+functional training+CPM system group than in pressure glove alone group (
P <0.05); the hand scar score of patients was significantly lower in pressure glove+functional training group and pressure glove+functional training+CPM system group than in pressure glove alone group (
P <0.05 or
P <0.01), and the hand scar score of patients was significantly lower in pressure glove+functional training+CPM system group than in pressure glove+functional training group (
P <0.05). Compared with those before treatment, the upper limb function scores of patients were significantly increased (
t =-5.295, -7.252, -15.342,
P <0.01) and the hand scar scores of patients were significantly decreased (
t =13.361, 16.982, 40.334,
P <0.01) in pressure glove alone group, pressure glove+functional training group, and pressure glove+functional training+CPM system group after 3 months of treatment. The differences in upper limb function score and hand scar score of patients before and after treatment in pressure glove+functional training+CPM system group were significantly higher than those in pressure glove+functional training group and pressure glove alone group (
P <0.05 or
P <0.01). The differences in upper limb function score and hand scar score of patients before and after treatment in pressure glove+functional training group were significantly higher than those in pressure glove alone group (
P <0.05). Conclusions Hand CPM system combined with functional training and pressure gloves can significantly improve the motion range of hand joint in treating early scar contracture after burn on the back of the hand, with better restoration of hand function and improvement of hand scar. Its effect is better than routine rehabilitation treatment such as functional training, etc., which is worthy of clinical reference.
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Key words:
- Burns /
- Cicatrix /
- Rehabilitation /
- Hand continuous passive motion system /
- Functional training /
- Joint motion range
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