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手功能评测训练系统对烧伤患者手功能康复的效果

鲁博,  马晓红,  付青青,  周亚琴,  衡雪,  谭江琳

文章导航 > 中华烧伤与创面修复杂志  >  > 优先出版
鲁博, 马晓红, 付青青, 等. 手功能评测训练系统对烧伤患者手功能康复的效果[J]. 中华烧伤与创面修复杂志, 2026, 42(11): 1-9. DOI: 10.3760/cma.j.cn501225-20250715-00306.
引用本文: 鲁博, 马晓红, 付青青, 等. 手功能评测训练系统对烧伤患者手功能康复的效果[J]. 中华烧伤与创面修复杂志, 2026, 42(11): 1-9. DOI: 10.3760/cma.j.cn501225-20250715-00306.
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Lu Bo,Ma Xiaohong,Fu Qingqing,et al.Effect of the hand function assessment and training system on hand function rehabilitation in patients with burns[J].Chin J Burns Wounds,2026,42(11):1-9.DOI: 10.3760/cma.j.cn501225-20250715-00306.
Citation: Lu Bo,Ma Xiaohong,Fu Qingqing,et al.Effect of the hand function assessment and training system on hand function rehabilitation in patients with burns[J].Chin J Burns Wounds,2026,42(11):1-9.DOI: 10.3760/cma.j.cn501225-20250715-00306.
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手功能评测训练系统对烧伤患者手功能康复的效果

doi: 10.3760/cma.j.cn501225-20250715-00306

  • 陆军军医大学（第三军医大学）第一附属医院全军烧伤研究所,创伤与化学中毒全国重点实验室,重庆　400038

基金项目: 

国家自然科学基金面上项目 82072188

重庆市科技传播与普及项目 CSTB2025KJCBPJKPHDYB10X0054

详细信息
    通讯作者:

    谭江琳,Email：tanjl@tmmu.edu.cn

Effect of the hand function assessment and training system on hand function rehabilitation in patients with burns

  • Institute of Burn Research, State Key Laboratory of Trauma and Chemical Poisoning, the First Affiliated Hospital of Army Medical University (the Third Military Medical University), Chongqing Key Laboratory for Wound Repair and Tissue Regeneration, Chongqing 400038, China

Funds: 

General Program of National Natural Science Foundation of China 82072188

Chongqing Science and Technology Communication and Popularization Project CSTB2025KJCBPJKPHDYB10X0054

More Information

    摘要
  • 摘要:   目的  探讨手功能评测训练系统对烧伤患者手功能康复的效果。  方法  该研究为回顾性队列研究。2021年1月—2024年12月,陆军军医大学（第三军医大学）第一附属医院全军烧伤研究所收治32例符合入选标准的手部烧伤患者。根据康复方式,将患者分为行常规康复训练的常规康复组[男13例、女3例,年龄（43±14）岁]和在常规康复训练基础上增加手功能评测训练系统训练的系统康复组[男15例、女1例,年龄（38±12）岁],每组均30只患手。采用总主动活动度（TAM）法评定患者治疗前和治疗4周后患手手指关节活动度,并记录治疗4周后患手改善程度。治疗前和治疗4周后,记录患手握力与捏力,采用视觉模拟评分法对患手疼痛、瘙痒程度分别进行评分,采用改良Barthel指数（MBI）量表和功能独立性评定（FIM）量表评估患者日常生活活动能力,并进一步记录FIM量表中自我照顾部分（进食、梳洗、洗澡、穿上衣、穿下衣和如厕）的各维度得分以反映患者上肢功能状况。  结果  组内比较显示,常规康复组和系统康复组患者治疗4周后患手TAM总和分别为（726±192）°、（709±242）°,均明显高于治疗前的（633±208）°、（564±244）°（t值分别为-7.25、-7.65,P<0.05）。治疗4周后,系统康复组患者患手改善程度明显优于常规康复组（RR为4.50,95%CI为1.06~19.11,Z=-1.99,P<0.05）。组内比较显示,常规康复组患者治疗4周后患手握力与捏力均较治疗前明显升高（t值分别为-6.90、-6.61,P<0.05）,系统康复组患者治疗4周后患手握力与捏力均较治疗前明显升高（t值分别为-11.89、-14.98,P<0.05）；组间比较显示,系统康复组患者治疗4周后患手握力、捏力均明显高于常规康复组（t值分别为3.07、2.97,P<0.05）。组内比较显示,与治疗前相比,常规康复组患者治疗4周后患手患手瘙痒评分、系统康复组患者治疗4周后患手疼痛评分均明显升高（Z值分别为-2.31、-2.17,P<0.05）；组间比较显示,系统康复组患者治疗4周后患手疼痛评分明显高于常规康复组（Z=-2.53,P<0.05）。组内比较显示,常规康复组患者治疗4周后患手MBI量表评分、FIM量表评分均明显高于治疗前（t值分别为-3.62、-3.72,P<0.05）,系统康复组患者治疗4周后患手MBI量表评分、FIM量表评分均明显高于治疗前（t值分别为-3.83、-4.29,P<0.05）；组间比较显示,系统康复组患者治疗4周后患手FIM量表评分明显高于常规康复组（t=-1.02,P<0.05）。组内比较显示,常规康复组患者治疗4周后患手FIM自我照顾部分的进餐、梳洗、洗澡、穿上衣、穿下衣、如厕维度的评分均明显高于治疗前（t值分别为-5.57、-5.67、-5.44、-4.56、-3.71、-4.03,P<0.05）,系统康复组患者治疗4周后患手FIM自我照顾部分的进餐、梳洗、洗澡、穿上衣、穿下衣、如厕维度的评分均明显高于治疗前（t值分别为-6.96、-9.52、-12.48、-4.68、-7.07、-7.11,P<0.05）；组间比较显示,系统康复组患者治疗4周后患手FIM自我照顾部分的洗澡、穿上衣、穿下衣、如厕维度的评分均明显高于常规康复组（t值分别为-3.90、-2.89、-3.38、-4.19,P<0.05）。  结论  手功能评测训练系统能够改善烧伤患者患手关节活动度、增加握力与捏力,提高患者日常生活活动能力,改善患者上肢功能,可为烧伤患者手功能恢复提供帮助。

     

    Abstract:   Objective  To investigate the effect of the hand function assessment and training system on hand function rehabilitation in patients with burns.  Methods  This was a retrospective cohort study. From January 2021 to December 2024, 32 patients with hand burns who met the inclusion criteria were admitted to the Institute of Burn Research, the First Affiliated Hospital of Army Medical University (Third Military Medical University). According to the rehabilitation method, patients were divided into routine rehabilitation group (13 males and 3 females, aged (43±14) years) receiving routine rehabilitation training and system rehabilitation group (15 males and 1 female, aged (38±12) years) receiving additional training with the hand function assessment and training system on the basis of routine rehabilitation training, with 30 affected hands in each group. The total active motion (TAM) method was used to assess the range of motion of finger joints of affected hands before treatment and at 4 weeks after treatment, and the improvement degree of affected hands was recorded at 4 weeks after treatment. Before treatment and at 4 weeks after treatment, grip strength and pinch strength of affected hands were recorded; the severity of pain and pruritus of affected hands was scored using the Visual Analogue Scale; activities of daily living were assessed using the modified Barthel Index (MBI) and the Functional Independence Measure (FIM); and the scores of each dimension of the self-care subscale of FIM (eating, grooming, bathing, dressing upper body, dressing lower body, and toileting) were further recorded to reflect upper limb function.  Results  Within-group comparison showed that the total TAM of affected hands in routine rehabilitation group and system rehabilitation group at 4 weeks after treatment was (726±192)° and (709±242)°, respectively, both significantly higher than (633±208)° and (564±244)° before treatment (with t values of -7.25 and -7.65, respectively, P<0.05). At 4 weeks after treatment, the improvement degree of affected hands in system rehabilitation group was significantly better than that in routine rehabilitation group (RR=4.50, with a 95%CI value of 1.06–19.11, Z=-1.99, P<0.05). Within-group comparison showed that grip strength and pinch strength of affected hands in routine rehabilitation group at 4 weeks after treatment were significantly higher than those before treatment (with t values of -6.90 and -6.61, respectively, P<0.05), and grip strength and pinch strength of affected hands in system rehabilitation group at 4 weeks after treatment were significantly higher than those before treatment (with t values of -11.89 and -14.98, respectively, P<0.05); between-group comparison showed that grip strength and pinch strength of affected hands in system rehabilitation group at 4 weeks after treatment were significantly higher than those in routine rehabilitation group (with t values of 3.07 and 2.97, respectively, P<0.05). Within-group comparison showed that compared with before treatment, the pruritus score of affected hands in routine rehabilitation group and the pain score of affected hands in system rehabilitation group were significantly increased at 4 weeks after treatment (with Z values of -2.31 and -2.17, respectively, P<0.05); between-group comparison showed that the pain score of affected hands in system rehabilitation group at 4 weeks after treatment was significantly higher than that in routine rehabilitation group (Z=-2.53, P<0.05). Within-group comparison showed that the MBI score and FIM score of affected hands in routine rehabilitation group at 4 weeks after treatment were significantly higher than those before treatment (with t values of -3.62 and -3.72, respectively, P<0.05), and the MBI score and FIM score of affected hands in system rehabilitation group at 4 weeks after treatment were significantly higher than those before treatment (with t values of -3.83 and -4.29, respectively, P< 0.05); between-group comparison showed that the FIM score of affected hands in system rehabilitation group at 4 weeks after treatment was significantly higher than that in routine rehabilitation group (t=-1.02, P<0.05). Within-group comparison showed that the scores of eating, grooming, bathing, dressing upper body, dressing lower body, and toileting dimensions of the self-care subscale of FIM of affected hands in routine rehabilitation group at 4 weeks after treatment were significantly higher than those before treatment (with t values of -5.57, -5.67, -5.44, -4.56, -3.71, and -4.03, respectively, P<0.05), and the scores of eating, grooming, bathing, dressing upper body, dressing lower body, and toileting dimensions of the self-care subscale of FIM of affected hands in system rehabilitation group at 4 weeks after treatment were significantly higher than those before treatment (with t values of -6.96, -9.52, -12.48, -4.68, -7.07, and -7.11, respectively, P<0.05); between-group comparison showed that the scores of bathing, dressing upper body, dressing lower body, and toileting dimensions of the self-care subscale of FIM of affected hands in system rehabilitation group at 4 weeks after treatment were significantly higher than those in routine rehabilitation group (with t values of -3.90, -2.89, -3.38, and -4.19, respectively, P<0.05).  Conclusions  The hand function assessment and training system can improve the range of motion of affected hand joints, increase grip strength and pinch strength, enhance activities of daily living, and improve upper limb function in patients with burns, thus providing assistance for hand function recovery in burn patients.

     

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    Table  1.   2组烧伤患者临床资料比较

    组别患者性别（例）患者年龄（岁,x¯±s）患手位置（只）患手烧伤深度（只）患者烧伤总面积（%TBSA,x¯±s）患手致伤因素（只）患手创面愈合时间（d,x¯±s）
    男女左右深Ⅱ度Ⅲ度火焰烧伤高温烫伤
    常规康复组13343±14151525547±2928250±20
    系统康复组15138±12151526446±2726444±22
    统计量值—t=1.58—χ2=0.13t=0.10—t=-1.13
    P值0.6000.118>0.9990.7180.9220.6710.262
    注：常规康复组患者行常规康复训练,系统康复组患者在常规康复训练基础上增加手功能评测训练系统训练,2组患者例数均为16,患手只数均为30；手背瘢痕面积占比=手背瘢痕面积÷手背总面积×100%；“—”表示无此统计量值
    下载: 导出CSV

    Table  2.   两组烧伤患者治疗前和治疗4周后患手握力与捏力比较(N,x¯±s)

    组别与时间点例数握力捏力
    常规康复组16
    治疗前71±4036±18
    治疗4周后76±4040±22
    系统康复组16
    治疗前53±4531±13
    治疗4周后116±6258±18
    t1值-6.90-6.61
    P1值<0.001<0.001
    t2值-11.89-14.98
    P2值<0.001<0.001
    t3值1.381.17
    P3值0.1720.248
    t4值3.072.97
    P4值0.0030.004
    注：常规康复组患者行常规康复训练,系统康复组患者在常规康复训练基础上增加手功能评测训练系统训练,2组患者患手只数均为30,即表格中数据的样本数为30；t1值、P1值为常规康复组组内比较所得,t2值、P2值为系统康复组组内比较所得,t3值、P3值为两组间治疗前比较所得,t4值与P4值为两组间治疗4周后比较所得
    下载: 导出CSV

    Table  3.   两组烧伤患者治疗前和治疗4周后患手疼痛瘙痒评分比较[分,M（Q1,Q3）]

    组别与时间点例数疼痛瘙痒
    常规康复组16
    治疗前2.50（0.00,4.00）3.50（1.50,5.25）
    治疗4周后1.00（0.00,3.00）5.00（4.00,6.00）
    系统康复组16
    治疗前1.50（0.00,5.00）4.00（2.00,6.00）
    治疗4周后3.00（0.75,7.00）5.00（3.00,5.25）
    Z1值-0.98-2.31
    P1值0.3230.021
    Z2值-2.17-0.45
    P2值0.0310.655
    Z3值-0.62-1.34
    P3值0.5330.174
    Z4值-2.53-0.28
    P4值0.0110.783
    注：常规康复组患者行常规康复训练,系统康复组患者在常规康复训练基础上增加手功能评测训练系统训练,2组患者患手只数均为30,即表格中数据的样本数为30；Z1值、P1值为常规康复组组内比较所得,Z2值、P2值为系统康复组组内比较所得,Z3值、P3值为两组间治疗前比较所得,Z4值与P4值为两组间治疗4周后比较所得
    下载: 导出CSV

    Table  4.   两组烧伤患者治疗前和治疗4周后日常生活能力评分比较(分,x¯±s)

    组别与时间点例数MBI量表评分FIM量表评分
    常规康复组16
    治疗前81±14110±15
    治疗4周后88±11115±14
    系统康复组16
    治疗前78±17106±14
    治疗4周后90±6117±6
    t1值-3.62-3.72
    P1值0.0010.001
    t2值-3.83-4.29
    P2值0.001<0.001
    t3值-0.79-0.80
    P3值0.4280.421
    t4值-1.02-1.02
    P4值0.3120.047
    注：常规康复组患者行常规康复训练,系统康复组患者在常规康复训练基础上增加手功能评测训练系统训练,2组患者患手只数均为30,即表格中数据的样本数为30；MBI为改良Barthel指数,FIM为功能独立性评定；t1值、P1值为常规康复组组内比较所得,t2值、P2值为系统康复组组内比较所得,t3值、P3值为两组间治疗前比较所得,t4值与P4值为两组间治疗4周后比较所得
    下载: 导出CSV

    Table  5.   两组烧伤患者治疗前和治疗4周后FIM量表自我照顾部分评分比较(分,x¯±s)

    组别与时间点例数进餐梳洗洗澡穿上衣穿下衣如厕
    常规康复组16
    治疗前5.2±1.55.0±1.54.4±1.45.3±1.45.2±1.54.6±1.5
    治疗4周后6.2±0.96.1±0.95.2±1.16.1±1.06.0±1.15.3±1.0
    系统康复组16
    治疗前5.0±1.64.7±1.54.1±1.35.6±1.75.0±1.75.0±1.5
    治疗4周后6.7±0.86.5±0.96.2±1.06.7±0.66.7±0.66.3±0.9
    t1值-5.57-5.67-5.44-4.56-3.71-4.03
    P1值<0.001<0.001<0.001<0.001<0.001<0.001
    t2值-6.96-9.52-12.48-4.68-7.07-7.11
    P2值<0.001<0.001<0.001<0.001<0.001<0.001
    t3值0.490.960.67-0.750.41-1.06
    P3值0.6230.3420.5030.4600.6850.292
    t4值-2.41-1.72-3.90-2.89-3.38-4.19
    P4值0.0190.090<0.0010.0060.001<0.001
    注：常规康复组患者行常规康复训练,系统康复组患者在常规康复训练基础上增加手功能评测训练系统训练,2组患者患手只数均为30,即表格中数据的样本数为30；FIM为功能独立性评定；t1值、P1值为常规康复组组内比较所得,t2值、P2值为系统康复组组内比较所得,t3值、P3值为两组间治疗前比较所得,t4值与P4值为两组间治疗4周后比较所得
    下载: 导出CSV
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出版历程
  • 收稿日期:  2025-07-15
  • 网络出版日期:  2026-11-02

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