Influence of muscle energy technology combined with Maitland joint mobilization surgery on the elbow joint flexion function in patients with deep burn of elbow joint
-
摘要:
目的 探讨肌肉能量技术（MET）联合Maitland关节松动术对肘关节深度烧伤患者肘关节屈曲功能的影响。 方法 采用回顾性临床对照研究方法。2020年1月—2022年1月，武汉大学同仁医院暨武汉市第三医院治疗53例符合入选标准的深度烧伤后肘关节屈曲功能障碍患者，其中男32例、女21例，年龄（37±12）岁。根据采用的治疗方式将患者分为单纯常规治疗组（15例）、常规治疗+关节松动术组（18例）和常规治疗+关节松动术+MET组（20例）。治疗前、治疗2个月后，分别采用量角器测量患者肘关节活动度，Mayo肘关节功能评分评价肘关节功能，便携式肌力测试仪测量伸肘肌肌力，视觉模拟评分法评估疼痛程度。对数据行单因素方差分析、LSD检验、配对样本 t检验、Kruskal-Wallis H检验、Wilcoxon符号秩和检验、 χ 2检验、Fisher确切概率法检验及Bonferroni校正。 结果 治疗2个月后，常规治疗+关节松动术组、常规治疗+关节松动术+MET组患者肘关节活动度、肘关节功能评分［（103±12）°、60（50，66）分，（131±14）°、73（65，80）分］分别明显大于、高于单纯常规治疗组［（77±15）°、45（35，50）分， P值均<0.05］，常规治疗+关节松动术+MET组患者肘关节活动度、肘关节功能评分分别明显大于、高于常规治疗+关节松动术组（ P值均<0.05）。治疗2个月后，常规治疗+关节松动术+MET组患者伸肘肌肌力、疼痛评分分别明显大于、低于单纯常规治疗组和常规治疗+关节松动术组（ P值均<0.05），常规治疗+关节松动术组患者伸肘肌肌力、疼痛评分均与单纯常规治疗组相近（ P>0.05）。单纯常规治疗组、常规治疗+关节松动术组、常规治疗+关节松动术+MET组患者治疗2个月后肘关节活动度和伸肘肌肌力（ t值分别为9.37、25.54、28.71，6.70、7.20、7.01， P<0.05）、肘关节功能评分和疼痛评分（ Z值分别为3.15、3.63、3.93，3.30、3.52、3.84， P<0.05）均较治疗前明显改善。 结论 MET联合Maitland关节松动术可有效改善肘关节深度烧伤患者肘关节活动度、肘关节功能、伸肘肌肌力以及疼痛情况，值得推广。 Abstract:Objective To investigate the influence of muscle energy technology (MET) combined with Maitland joint mobilization surgery on the elbow joint flexion function in patients with deep burn of elbow joint. Methods A retrospective controlled clinical trial was conducted. From January 2020 to January 2022, 53 patients with elbow joint flexion dysfunction after deep burns who met the inclusion criteria were treated in Tongren Hospital of Wuhan University ＆ Wuhan Third Hospital, including 32 males and 21 females, aged (37±12) years. According to the treatment method used, the patients were divided into conventional treatment alone group (15 cases), conventional treatment+joint mobilization surgery group (18 cases), and conventional treatment+joint mobilization surgery+MET group (20 cases). Before treatment and 2 months after treatment, the patient's elbow joint range of motion was measured using a protractor, the Mayo elbow joint function score was used to evaluate elbow joint function, a portable muscle strength tester was used to measure elbow extensor muscle strength, and visual analogue scale was used to evaluate pain degree. Data were statistically analyzed with one-way analysis of variance, least significant difference test, paired sample t test, Kruskal-Wallis H test, Wilcoxon signed rank-sum test, chi-square test, Fisher's exact probability test, and Bonferroni correction. Results After two months of treatment, the elbow joint range of motion and elbow joint function scores of patients in conventional treatment+joint mobilization surgery group and conventional treatment+joint mobilization surgery+MET group ((103±12)° and 60 (50, 66), (131±14)° and 73 (65, 80)) were significantly larger and higher than those in conventional treatment alone group ((77±15)° and 45 (35, 50), Pvalues all <0.05), respectively. The elbow joint range of motion and elbow joint function scores of patients in conventional treatment+joint mobilization surgery+MET group were significantly larger and higher than those in conventional treatment+joint mobilization surgery group ( Pvalues all <0.05), respectively. After two months of treatment, the elbow extensor muscle strength and pain score of patients in conventional treatment+joint mobilization surgery+MET group were respectively significantly larger and lower than those in conventional treatment alone group and conventional treatment+joint mobilization surgery group ( Pvalues all <0.05). The elbow extensor muscle strength and pain score of patients in conventional treatment+joint mobilization surgery group were similar to those in conventional treatment alone group ( P>0.05). The elbow joint range of motion and elbow extensor muscle strength (with t values of 9.37, 25.54, 28.71, 6.70, 7.20, and 7.01, respectively, P<0.05), elbow joint function scores and pain scores (with Z values of 3.15, 3.63, 3.93, 3.30, 3.52, and 3.84, respectively, P<0.05) of patients in conventional treatment alone group, conventional treatment+joint mobilization surgery group, and conventional treatment+joint mobilization surgery+MET group after two months of treatment were significantly improved compared with those before treatment. Conclusions The combination of MET and Maitland joint mobilization surgery can effectively improve elbow joint range of motion, elbow joint function, elbow extensor muscle strength, and pain of patients with deep elbow joint burns, therefore it is worthy of promotion. -
Key words:
- Burns /
- Rehabilitation /
- Elbow joint /
- Muscle strength /
- Joint range of motion
-
参考文献
(30) [1] 茹天峰,李菲虹,陈佩,等.关节活动训练系统治疗深度烧伤后关节功能障碍的临床效果[J].中华烧伤杂志,2017,33(5):267-271.DOI: 10.3760/cma.j.issn.1009-2587.2017.05.003. [2] RobertsBL. Soft tissue manipulation: neuromuscular and muscle energy techniques[J].J Neurosci Nurs, 1997,29(2):123-127.DOI: 10.1097/01376517-199704000-00006. [3] 李剑峰,张君,黑光,等.肌内效贴联合肌肉能量技术治疗肱骨外上髁炎的疗效观察[J].中华物理医学与康复杂志,2018,40(3):208-210.DOI: 10.3760/cma.j.issn.0254-1424.2018.03.013. [4] 隋荣玲,杨洪兴,于丽瑛,等.视觉反馈下肌肉能量技术对肘关节骨折患者术后上肢功能康复的影响[J].国际医药卫生导报,2019,25(17):2908-2910.DOI: 10.3760/cma.j.issn.1007-1245.2019.17.018. [5] Cioppa-MoscaJ, CahillJB, CavanaughJT, et al.骨科术后康复指南[M]. 陆芸,周谋望,李世民,译.天津:天津科技翻译出版公司,2009:54-55. [6] ChoYS,JeonJH,HongA,et al.The effect of burn rehabilitation massage therapy on hypertrophic scar after burn: a randomized controlled trial[J].Burns,2014,40(8):1513-1520.DOI: 10.1016/j.burns.2014.02.005. [7] 吴坤平,陈佩,茹天峰,等.功率自行车康复训练对大面积烧伤致下肢功能障碍患者股四头肌和步行能力影响的前瞻性随机对照研究[J].中华烧伤与创面修复杂志,2022,38(5):447-453.DOI: 10.3760/cma.j.cn501120-20210221-00060. [8] 田凌云,李映兰,吴英,等.压力疗法治疗增生性瘢痕患者有效性的荟萃分析[J].中华烧伤杂志,2019,35(9):668-675.DOI: 10.3760/cma.j.issn.1009-2587.2019.09.005. [9] 刘悦,王连召.瘢痕综合治疗的临床实践与思考[J].中华整形外科杂志,2020,36(10):1069-1074.DOI: 10.3760/cma.cn114453-20201009-00523. [10] ZaidiF,AhmedI. Effectiveness of muscle energy technique as compared to Maitland mobilisation for the treatment of chronic sacroiliac joint dysfunction[J].J Pak Med Assoc,2020,70(10):1693-1697.DOI: 10.5455/JPMA.43722. [11] LiLL, HuXJ, DiYH, et al.Effectiveness of Maitland and Mulligan mobilization methods for adults with knee osteoarthritis: a systematic review and meta-analysis[J].World J Clin Cases,2022,10(3):954-965.DOI: 10.12998/wjcc.v10.i3.954. [12] 孙志成,莫非,管重远,等.等速训练结合康复手法松解治疗创伤后肘关节僵直的疗效观察[J].中华物理医学与康复杂志,2016,38(6):444-446.DOI: 10.3760/cma.j.issn.0254-1424.2016.06.012. [13] MorreyB, AdamsRA. Semiconstrained arthroplasty for the treatment of rheumatoid arthritis of the elbow[J]. J Bone Joint Surg Am,1992,74(4):479-490. [14] 任虹,肖爱伟,种肖宇,等.玻璃酸钠关节腔内注射联合松解术及中药熏洗治疗创伤后肘关节僵硬的疗效观察[J].中华物理医学与康复杂志,2022,44(6):533-535.DOI: 10.3760/cma.j.issn.0254-1424.2022.06.012. [15] 赵贤,陈辰,公茂琪,等.静脉联合局部应用氨甲环酸对肘关节松解围手术期失血量的影响研究[J].中华创伤骨科杂志,2021,23(8):651-655.DOI: 10.3760/cma.j.cn115530-20210105-00005. [16] ShahgholiL,BengtsonKA,BishopAT,et al. A comparison of manual and quantitative elbow strength testing[J]. Am J Phys Med Rehabil,2012,91(10):856-862.DOI: 10.1097/PHM.0b013e31825f14f9. [17] 王芳,李剑峰,张君.体外冲击波联合肱骨外上髁及冈下肌内热针治疗肱骨外上髁炎临床观察[J].中华物理医学与康复杂志,2022,44(4):331-333.DOI: 10.3760/cma.j.issn.0254-1424.2022.04.009. [18] MorreyBF.Post-traumatic contracture of the elbow.Operative treatment,including distraction arthroplasty[J].J Bone Joint Surg Am,1990,72(4):601-618. [19] 李桦,陈浩杰,陈国华,等.电烧伤后肘关节纤维性强直的解剖学基础与临床治疗[J].中华烧伤杂志,2005,21(3):207-209. DOI: 10.3760/cma.j.issn.1009-2587.2005.03.014. [20] 缪鸿石.康复医学理论与实践[M].上海:上海科学技术出版社,2000:287. [21] 万里,赵晓红,朱奕,等.改良关节松动术治疗创伤后膝关节功能障碍的疗效观察[J].中华物理医学与康复杂志,2011,33(6):477-478.DOI: 10.3760/cmaj.issn.0254-1424.2011.06.025. [22] 张振君,白伦浩.两种关节松动术联合肌力训练用于肩关节撞击综合征的效果比较[J].中国基层医药,2020,27(20):2501-2504.DOI: 10.3760/cma.j.issn.1008-6706.2020.20.016. [23] 黄思思,朱兰,陈悦,等.高能量激光联合关节松动术治疗肩周炎的临床疗效观察[J].中华物理医学与康复杂志,2018,40(9):682-684. DOI: 10.3760/cma.j.issn.0254-1424.2018.09.012. [24] 王刚,张德清,林元平,等.体外冲击波与关节松动术治疗肩关节周围炎的临床疗效对比[J].中华物理医学与康复杂志,2006,28(2): 110-113.DOI: DOI:10.3760/j:issn:0254-1424.2006.02.012. [25] 汪娟,徐一宏,杨景朝,等.肌肉能量技术对久坐人群颈椎关节活动度的影响[J].中华物理医学与康复杂志,2021,43(8):704-706.DOI: 10.3760/cma.j.issn.0254-1424.2021.08.008. [26] RiddleDL,PulisicM,PidcoeP, et al. Risk factors for plantar fasciitis: a matched case-control study[J]. J Bone Joint Surg Am,2003,85(5):872-877.DOI: 10.2106/00004623-200305000-00015. [27] 董明,刘守国,励建安,等.肌肉能量技术结合关节松动术治疗肩周炎的临床疗效分析[J].中华物理医学与康复杂志,2013,35(10):795-799.DOI: 10.3760/cma.j.issn.0254-1424.2013.10.013. [28] 廖亮华,江兴妹,叶志卫,等.早期康复对肘关节骨折术后功能恢复的影响[J].中国康复理论与实践,2010,16(9):867-869.DOI: 10.3969/j.issn.1006-9771.2010.09.030. [29] 牛岩,黄力平,曹龙军,等.静力牵伸与等长收缩对颈肩肌肉疼痛患者上斜方肌肌电图特征性变化及疼痛指数的影响[J].中国康复医学杂志,2016,31(4):411-416. DOI: 10.3969/j.issn.1001-1242.2016.04.007. [30] ThorénP,FlorasJS,HoffmannP,et al.Endorphins and exercise: physiological mechanisms and clinical implications[J]. Med Sci Sports Exerc,1990,22(4):417-428. -
表1 3组深度烧伤后肘关节屈曲功能障碍患者临床资料比较
组别 例数 性别（例） 年龄（岁， 烧伤总面积（%TBSA， 上肢深度烧伤面积［%TBSA， M（ Q 1， Q 3）］ 肘关节处移植皮片类型（例） 肘关节处皮片移植方式（例） 伤后创面基本愈合时间（d， 创面基本愈合后开始康复治疗时间（d， 男 女 全厚皮 中厚皮 刃厚皮 大张皮 网状皮 邮票皮 单纯常规治疗组 15 11 4 35±13 49±8 13（9，16） 5 8 2 7 7 1 47±14 9.2±2.2 常规治疗+关节松动术组 18 12 6 40±11 54±11 11（8，15） 6 9 3 11 5 2 46±9 10.8±2.9 常规治疗+关节松动术+MET组 20 9 11 37±12 53±9 12（6，16） 6 12 2 8 10 2 43±13 9.9±2.4 统计量值 χ 2=3.33 F=0.48 F=1.05 H=0.73 — — F=0.57 F=1.74 P值 0.189 0.625 0.357 0.695 0.969 0.693 0.568 0.187 注：MET为肌肉能量技术，TBSA为体表总面积；“—”表示无此项 
下载: 导出CSV
表2 3组深度烧伤后肘关节屈曲功能障碍患者治疗前后肘关节活动度比较（°，
组别 例数 治疗前 治疗2个月后 t值 P值 单纯常规治疗组 15 34±11 77±15 9.37 <0.001 常规治疗+关节松动术组 18 27±10 103±12 a 25.54 <0.001 常规治疗+关节松动术+MET组 20 28±9 131±14 ab 28.71 <0.001 F值 2.62 66.11 P值 0.083 <0.001 注：MET为肌肉能量技术；与单纯常规治疗组比较， a P<0.05；与常规治疗+关节松动术组比较， b P<0.05
下载: 导出CSV
表3 3组深度烧伤后肘关节屈曲功能障碍患者治疗前后肘关节功能评分比较[分， M（ Q 1， Q 3）]
组别 例数 治疗前 治疗2个月后 Z值 P值 单纯常规治疗组 15 25（25，35） 45（35，50） 3.15 0.002 常规治疗+关节松动术组 18 33（25，45） 60（50，66） a 3.63 <0.001 常规治疗+关节松动术+MET组 20 30（25，39） 73（65，80） ab 3.93 <0.001 H值 1.55 23.50 P值 0.462 <0.001 注：MET为肌肉能量技术；与单纯常规治疗组比较， a P<0.05；与常规治疗+关节松动术组比较， b P<0.05
下载: 导出CSV
表4 3组深度烧伤后肘关节屈曲功能障碍患者治疗前后伸肘肌肌力比较（N，
组别 例数 治疗前 治疗2个月后 t值 P值 单纯常规治疗组 15 34±14 58±6 6.70 <0.001 常规治疗+关节松动术组 18 40±10 58±8 7.20 <0.001 常规治疗+关节松动术+MET组 20 39±13 64±8 ab 7.01 <0.001 F值 1.15 4.01 P值 0.324 0.024 注：MET为肌肉能量技术；与单纯常规治疗组比较， a P<0.05；与常规治疗+关节松动术组比较， b P<0.05
下载: 导出CSV
表5 3组深度烧伤后肘关节屈曲功能障碍患者治疗前后疼痛评分比较[分， M（ Q 1， Q 3）]
组别 例数 治疗前 治疗2个月后 Z值 P值 单纯常规治疗组 15 5（5，6） 4（3，5） 3.30 0.001 常规治疗+关节松动术组 18 6（5，7） 4（3，5） 3.52 <0.001 常规治疗+关节松动术+MET组 20 6（6，7） 2（1，3） ab 3.84 <0.001 H值 3.50 14.47 P值 0.174 0.001 注：MET为肌肉能量技术；与单纯常规治疗组比较， a P<0.05；与常规治疗+关节松动术组比较， b P<0.05
下载: 导出CSV
-
图(2) / 表(5)
计量
- 文章访问数: 602
- HTML全文浏览量: 103
- PDF下载量: 82
- 被引次数: 0
