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
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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
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参考文献
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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 
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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
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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
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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
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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
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