肱骨近端肿瘤保肢治疗围手术期的系统康复干预  

Systematic rehabilitation intervention in the treatment of tumor of proximal humerus with limb salvage during perioperative period

作　　者：肖睿[1] 屠重琪[1] 李小彪[1] 宋跃明[1] 黄富国[1] 

机构地区：[1]四川大学华西医院骨科,四川省成都市610041

出　　处：《中国临床康复》2005年第26期34-36,共3页Chinese Journal of Clinical Rehabilitation

摘　　要：目的:探讨肱骨近端肿瘤应用保肢手术后围手术期康复治疗的疗效。方法:纳入四川大学华西医院骨科1980-04/2004-08住院治疗的肱骨近端肿瘤患者109例,根据患者知情自愿原则分为治疗组68例,对照组41例。采用瘤段切除、人工肱骨头置换或全肩关节置换或异体肱骨头移植等方法重建肩关节功能,并辅以恶性肿瘤的术前及术后应用抗肿瘤药物治疗。治疗组术后24h开始实施系统个性化康复治疗方案:①手术当日,患者麻醉清醒后即开始在胸前固定位做指、腕、肘主动等长练习。每个动作重复五六次,以后每天增加2次左右,达到20次。②术后第1天开始帮助患者在床上做等长握拳运动,5min/次,2h/天。③术后第3天开始,在患者能够耐受的范围内作腕、肘关节屈伸等被动等张活动。疗效评定根据治疗后两组患者Enneking肢体恶性肿瘤保肢术后功能评价评分:正常30分;优24～30分;良19～23分;可12～18分;差≤11分。优良率=(优例数+良例数)/总例数×100%。结果:按实际处理分析,进入结果分析109例,治疗组68例,对照组41例。①两组患者Enneking肢体恶性肿瘤保肢术后功能评价评分:治疗组均高于对照组(治疗后1周:19.7和12.2分,治疗后2周:23.8和15.6分,P<0.05)。②术后3周肢体功能优良率:治疗组高于对照组犤85%(58/68),41%(17/41),P<0.05犦。结论:肱骨近端肿瘤应用保肢手术并实行围手术期的个性化和系统性康复治疗,能够促进骨折愈合和功能恢复。AIM： To explore the effect of postoperative rehabilitation treatment following limb salvage for tumor of proximal humerus. METHODS： 109 inpatients with tumor of proximal humerus in Department of Orthopaedic Surgery, West China Hospital, Sichuan University from April 1980 to August 2004 were included. According to the principle of agreement of patients, they were divided into treatment group with 68 cases and control group with 41 cases. The resection of tumor segment, permutation of artificial head of humerus or total shoulder joint replacement or allograft of head of humerus transplantation etc. methods were performed for functional reconstruction of the shoulder joint, and anti-tumor drug treatment was also performed before and after operation on malignant tumor. Twenty-four hours after operation patients in treatment group were performed rehabilitative treatment method with system individuation： ① At the date of operation, after wakefulness following narcosis the patients be- gan to do finger, wrist and elbow initiatively etc. length exercise. Every movement repeated for five or six times, from then about twice were added every day, till reached 20 times. ② At the first day post-operation the patients were helped to do equal length clench fist movement on bed for 5 minutes once and 2 hours a day. ③ From the third day post-operation, the flexion and extension of wrist and elbow joint etc. passively equal extension movement within the range of the tolerance of patients. The evaluation of effect was according to the limb postoperative functional assessment score of limb salvage for tumor of proximal humerus of the patients in the two groups post-operation： normal, 30 points; excellent, 24-30 points; good, 19-23 points; so-so, 12-18 points; bad, ≤11 points. Excellent and good rate=（the number of excellent ＋ the number of good）/total number×100%. RESULTS： According to the intention-to-treat analysis, 109 cases were involved in the result analysis with 68 cases in treatment group and 41 case

关 键 词：肱骨上端 骨肿瘤 保肢手术 康复 肿瘤患者 围手术期 保肢治疗 肱骨近端 康复干预 实施系统 

分 类 号：R473.73[医药卫生—护理学] R738.1[医药卫生—临床医学]