自制静态渐进性支具阶梯式治疗烧伤后瘢痕挛缩致手屈曲功能障碍的效果

赵海洋; 周琴; 刘佳琦; 张万福; 朱婵; 徐婧; 韩军涛; 胡大海; 官浩

doi:10.3760/cma.j.cn501225-20240606-00216

自制静态渐进性支具阶梯式治疗烧伤后瘢痕挛缩致手屈曲功能障碍的效果

doi: 10.3760/cma.j.cn501225-20240606-00216

空军军医大学第一附属医院全军烧伤中心,烧伤与皮肤外科,西安　　710032

基金项目:

国家自然科学基金面上项目 82272268

陕西省重点研发计划 2023-YBSF-578

军队护理创新与培育专项计划 2023HL046

详细信息

通讯作者:
官浩,Email：guanhao2020@yeah.net

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出版历程
- 收稿日期: 2024-06-06

Effect of self-made static progressive braces in the stepwise treatment of hand flexion dysfunction caused by scar contracture after burn injury

Department of Burns and Cutaneous Surgery, Burn Center of PLA, the First Affiliated Hospital of Air Force Medical University, Xi'an 710032, China

Funds:

General Program of National Natural Science Foundation of China 82272268

Shaanxi Provincial Key Research and Development Plan of China 2023-YBSF-578

Military Nursing Innovation and Cultivation Program 2023HL046

More Information

Corresponding author: Guan Hao, Email: guanhao2020@yeah.net

摘要

摘要: 目的探讨自制静态渐进性支具阶梯式治疗烧伤后瘢痕挛缩致手屈曲功能障碍的效果。方法该研究为回顾性观察性研究。2022年1月—2024年3月,空军军医大学第一附属医院收治29例符合入选标准的采用自制静态渐进性支具阶梯式治疗瘢痕挛缩致手屈曲功能障碍的患者,其中男23例、女6例,年龄16~55岁,手背部烧伤深度为深Ⅱ~Ⅲ度。自制静态渐进性支具指自制静态渐进性关节牵伸器和自制静态渐进性手屈曲牵伸器。阶梯式治疗的第1个阶段选择在院治疗2~4周,治疗内容包括行常规康复训练和应用自制静态渐进性关节牵伸器训练。待掌指关节主动屈曲活动范围≥60°后,则可进阶到第2个阶段,即为期2周的居家远程康复治疗,治疗内容包括行自制静态渐进性关节牵伸器训练、自制静态渐进性手屈曲牵伸器训练等个体化运动训练。记录阶梯式治疗期间是否发生水疱、支具卡压、组织拉伤等不良事件。阶梯式治疗结束后,观察患手主动屈曲情况。随访时,测量患手总主动活动度,评估患手背部瘢痕及皮肤软组织延展性情况以及患者对疗效的满意度。末次随访时,参照中华医学会手外科学会上肢部分功能评定试用标准评价患手功能。结果在阶梯式治疗期间,2例患者腕关节处皮肤产生少许水疱,经对症处理后痊愈；其余患者未出现支具卡压、组织拉伤等不良事件。阶梯式治疗结束后,患手主动屈曲功能较佳,可基本握拳。随访1~3个月,患手总主动活动度为200~245°；手背部瘢痕质地较软、色泽较浅,皮肤软组织延展性良好；对疗效非常满意者22例、满意者6例、不满意者1例。末次随访时,患手功能评定为优者20例、良者9例。结论采用自制静态渐进性支具阶梯式治疗烧伤后瘢痕挛缩致手屈曲功能障碍的效果佳,并发症少；且2种自制静态渐进性牵伸器的取材方便、制作简单、经济有效、实用性强,值得临床推广。
- 烧伤 /
- 康复 /
- 设备设计 /
- 爪形手 /
- 静态渐进性牵伸技术
Abstract: Objective To explore the effect of self-made static progressive braces in the stepwise treatment of hand flexion dysfunction caused by scar contracture after burn injury. Methods This study was a retrospective observational study. From January 2022 to March 2024, the First Affiliated Hospital of Air Force Medical University admitted twenty-nine patients who met the inclusion criteria and used the self-made static progressive braces for stepwise treatment of hand flexion dysfunction caused by scar contracture, including 23 males and 6 females, aged 16 to 55 years. The depth of burn on the back of the hand was deep partial-thickness to full-thickness. The self-made static progressive brace referred to the self-made static progressive joint distractor and the self-made static progressive hand flexion distractor. The stepwise treatment was adopted. In the first stage, in-hospital treatment for 2 to 4 weeks was selected. The treatment contents included conventional rehabilitation training and training on the application of the self-made joint distractors. When the active flexion range of motion of the metacarpophalangeal joint was ≥60°, the second stage of treatment was carried out, that is, two weeks of home remote rehabilitation treatment. The treatment contents included individualized exercise training such as training with self-made static progressive joint distractors and training with self-made static progressive hand flexion distractors. Adverse events such as blister, brace compression, and tissue strain during the stepwise treatment were recorded. After the end of the stepwise treatment, the active flexion of the affected hand was observed. During follow-up, the total active range of motion of the affected hand was measured, and the extensibility of the scar and skin and soft tissue on the back of the affected hand and the patient's satisfaction with the therapeutic effect were evaluated. At the last follow-up, the function of the affected hand was evaluated according to the trial standards for evaluation of partial function of upper extremity by the Hand Surgery Society of Chinese Medical Association. Results During the stepwise treatment, a small amount of blisters developed on the skin at the wrist joint in 2 patients, which was cured after symptomatic treatment; the other patients had no adverse events such as brace compression and tissue strain. After the end of the stepwise treatment, the active flexion function of the hand was better, and the fist could be basically clenched. After 1-3 months of follow-up, the total active range of motion of the affected hand was 200-245°; the scar on the back of the hand was soft and light-colored, and the skin and soft tissue was malleable. Twenty-two patients were very satisfied with the curative effect, 6 patients were satisfied, and 1 patient was dissatisfied. At the last follow-up, there were 20 cases with excellent hand function and 9 cases with good hand function. Conclusions The stepwise treatment of hand flexion dysfunction caused by scar contracture after burn injury with self-made static progressive braces has a good effect and few complications. Moreover, the two self-made static progressive distractors are convenient in material acquisition, simple to make, cost-effective, and highly practical, which is worthy of clinical promotion.
- Burns /
- Rehabilitation /
- Equipment design /
- Claw shaped hand /
- Static progressive stretching technology
赵海洋：设计制作支具、实施康复训练、资料整理、论文撰写；周琴、官浩：经费支持、优化支具设计、论文指导；刘佳琦、张万福：手术实施、病历收集；朱婵、徐婧：实施康复训练、远程指导患者实施康复训练；韩军涛、胡大海：对文章的知识性内容作批评性审阅

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图 1 自制静态渐进性支具及其佩戴示例图。1A、1B、1C、1D.分别为自制静态渐进性关节牵伸器的普通市售渔轮、个体化设计制作的低温热塑板及环指掌指关节牵伸和拇指掌指关节牵伸示例图；1E、1F、1G、1H.分别为自制静态渐进性手屈曲牵伸器的平面图、立体图及佩戴、训练示例图

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图 2 自制静态渐进性支具阶梯式治疗例1患者右手烧伤后屈曲功能障碍的效果。2A.阶梯式治疗前,右手屈曲功能障碍；2B.阶梯式治疗第1天,行关节松动训练；2C.阶梯式治疗第2天,行压力手套和自制静态渐进性关节牵伸器治疗；2D.阶梯式治疗16 d后,行自制静态渐进性手屈曲牵伸器训练；2E、2F、2G.分别显示阶梯式治疗结束后,右手掌指关节及指尖关节屈曲功能基本正常,右手拇指捏力基本正常,右手握力基本正常；2H.随访2个月时,患者能自行驾驶机动车

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图 3 自制静态渐进性支具阶梯式治疗例2患者双手烧伤后屈曲功能障碍的效果。3A.入院时,双手组织水肿,呈蜡黄样改变；3B.皮片移植术后,右手僵硬、活动度差；3C、3D、3E、3F.分别为阶梯式治疗第1天对右手行海特光照射治疗、压力手套和指蹼压力垫治疗、手指筋膜加压带辅助下牵伸训练、自制静态渐进性关节牵伸器训练；3G.阶梯式治疗第2天,行拇指掌指关节渐进性牵伸训练；3H.离院前1 d,设计并制作个体化自制静态渐进性手屈曲牵伸器进行手屈曲训练；3I、3J、3K.分别显示阶梯式治疗结束后,患者右手背部皮肤组织弹性良好及延展性较佳,右手掌指关节屈曲基本正常,左手掌指关节屈曲基本正常且可自主握拳；3L.阶梯式治疗结束3周后随访时,患手能提1桶水

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