楔形足跟垫在特重度烧伤患者足下垂畸形治疗中的效果  

Effects of wedge-shaped heel pad in the treatment of extremely severe burn patients with foot drop deformity

作　　者：施加加 孙莹 彭志坚[3] Shi Jiajia;Sun Ying;Peng Zhijian(Department of Burn Rehabilitation,Kunshan Rehabilitation Hospital,Kunshan 215314,China;Department of Occupational Therapy,Kunshan Rehabilitation Hospital,Kunshan 215314,China;Department of General Surgery,Traditional Chinese Medicine Hospital of Kunshan,Kunshan 215300,China)

机构地区：[1]昆山市康复医院烧伤康复科,215314 [2]昆山市康复医院作业治疗科,215314 [3]昆山市中医医院普外科,215300

出　　处：《中华烧伤杂志》2021年第6期562-567,共6页Chinese Journal of Burns

基　　金：昆山市社会发展科技项目(KS1633)。

摘　　要：目的探讨楔形足跟垫在特重度烧伤患者足下垂畸形治疗中的效果。方法采用回顾性队列研究方法。2015年3月—2016年7月,昆山市康复医院烧伤康复科收治33例符合入选标准的特重度烧伤瘢痕致足下垂畸形患者,其中男18例、女15例,年龄为(38±9)岁。患者入院后行烧伤后综合康复治疗,根据患者足下垂畸形的程度,在患者鞋垫下方装配适当高度的楔形足跟垫。患者穿上装配楔形足跟垫的鞋进行站立、下蹲与行走训练。首次应用楔形足跟垫治疗前和治疗后即刻(下称治疗前、治疗后即刻)及治疗1个月,采用简易平衡量表评估患者站位平衡能力。应用楔形足跟垫治疗1、3、12个月,使用关节活动度测量尺测量患者双侧踝关节背屈、膝关节屈曲的主动活动度(AROM),使用皮尺测量患者下蹲时臀部离地最短距离和1 min步行距离,应用改良Barthel指数评定患者日常生活活动移动项(床椅间转移、行走、上下楼梯)的独立能力。对数据行Friedman检验、Wilcoxon秩和检验及不等距重复测量方差分析和Bonferroni校正。结果治疗后即刻,患者站位平衡能力为2.0(1.0,2.0)级,较治疗前的1.0(0,1.0)级明显升高(Z=-5.568,P<0.01);治疗1个月,患者站位平衡能力为3.0(2.5,3.0)级,较治疗后即刻明显上升(Z=-5.303,P<0.01)。治疗3、12个月,患者左、右侧踝关节背屈和左、右侧膝关节屈曲AROM较治疗1个月明显增加(Z=-4.860、-4.836、-4.965、-4.909,-5.037、-5.025、-5.020、-4.942,P<0.01);治疗12个月,患者左、右侧踝关节背屈和左、右侧膝关节屈曲AROM较治疗3个月明显增加(Z=-5.062、-4.962、-5.017、-4.944,P<0.01)。治疗3、12个月,患者臀部离地最短距离分别为(67±11)、(57±11)cm,较治疗1个月的(72±11)cm明显缩短(P<0.01);治疗12个月,患者臀部离地最短距离较治疗3个月明显缩短(P<0.01)。治疗3、12个月,患者1 min步行距离较治疗1个月明显增加(Z=-5.043、-5.016,P<0.01Objective To explore the effects of wedge-shaped heel pad in the treatment of foot drop deformity in extremely severe burn patients.Methods A retrospective cohort study method was conducted.From March 2015 to July 2016,33 patients with foot drop deformity caused by extremely severe burn scar who met the inclusion criteria were admitted to the Department of Burn Rehabilitation of Kunshan Rehabilitation Hospital,including 18 males and 15 females,aged(38±9)years.Patients received comprehensive post-burn rehabilitation treatment after admission,and the wedge-shaped heel pad with appropriate height was placed under the patients'insole,according to the degree of the foot drop deformity in patients.Standing,squatting,and walking exercises were performed after putting on shoes with wedge-shaped heel pad.Before and immediately after the first treatment(hereinafter referred to as before and immediately after treatment),and in 1 month after treatment with wedge-shaped heel pad,the Simple Balance Scale was used to evaluate the standing balance ability of patients.In 1,3,and 12 months after treatment,active ranges of motion(AROMs)of bilateral ankle joint dorsiflexion and knee joint flexion were measured with joint motion range measuring ruler,the shortest distance between buttocks of patients and the ground when squatting and walking distance in 1 min of patients were measured with measuring tape,and the independent ability of transferring between beds and chairs,walking,and walking up and down stairs in the movement items of activity of daily living(ADL)in patients were evaluated with modified Barthel index.Data were statistically analyzed with Friedman test,Wilcoxon rank sum test,unequal interval analysis of variance for repeated measurement,and Bonferroni correction.Results Immediately after treatment,the standing balance ability of patients was 2.0(1.0,2.0)levels,which was significantly higher than 1.0(0,1.0)level before treatment(Z=-5.568,P<0.01);in 1 month after treatment,the standing balance ability of patients was 3.

关 键 词：烧伤 踝关节 康复 辅助器具 

分 类 号：R64[医药卫生—外科学] R826.3[医药卫生—临床医学] R318.08