创伤后重度肘关节僵硬患者的综合康复治疗近期疗效及相关影响因素分析  

Short-term efficacy and analysis of related influencing factors of comprehensive rehabilitation in patients with severe post-traumatic elbow stiffness

作　　者：严攀[1] 张鑫[1] 向明[2] 杨金松 郭洁 Yan Pan;Zhang Xin;Xiang Ming;Yang Jinson;Guo Jie(Department of Rehabilitation,Sichuan Province Orthopedic Hospital,Chengdu 610041,China;Department of Upper Extremity,Sichuan Province Orthopedic Hospital,Chengdu 610041,China)

机构地区：[1]四川省骨科医院康复科,成都610041 [2]四川省骨科医院上肢科,成都610041

出　　处：《中华肩肘外科电子杂志》2022年第1期59-64,共6页Chinese Journal of Shoulder and Elbow(Electronic Edition)

基　　金：四川省中医骨科与运动康复临床医学研究中心项目(川科资[2019]29号)。

摘　　要：目的观察创伤后重度肘关节僵硬(活动范围≤60°)患者的综合康复近期疗效,并分析找出影响近期疗效的相关因素。方法选择2017年1月至2020年12月在四川省骨科医院康复科住院并采用中西医结合综合康复治疗方案(关节松动手法、静态牵伸支具治疗、主动运动疗法、冷疗以及中药外敷)的患者。对符合诊断及纳入标准的患者进行回顾性研究,将患者入院时和出院时的肘关节活动度范围、视觉模拟评分(visual analogue score,VAS)、肘关节功能(hospital of special surgery,HSS)评分、日常生活能力评定(activity of daily living,ADL)及活动度改善范围进行对比分析。并根据出院时肘关节屈伸活动度改善情况进行分组:改善范围>40°为A组、改善范围≤40°为B组。对两组患者的性别、年龄、暴力大小、住院时间、病程、是否手术、是否合并骨化性肌炎、是否合并尺神经炎、是否开放伤、是否合并肩或腕关节僵硬、是否复杂肘关节损伤进行单因素及多因素回归分析。结果患者入院和出院时肘关节活动度范围、VAS、HSS评分、ADL经独立样本t检验,差异均具有统计学意义(P值均<0.05),但出院时HSS评分70分以上者仅占29.7%。出院时肘关节活动度改善平均值为28.12°,P 50=25°,P 75=40°。治疗前、后肘关节活动度改善范围>40°的患者32例(A组),≤40°的69例(B组)。研究发现,两组入院时肘关节活动范围及住院时间差异无统计学意义。回归分析证实复杂性肘关节损伤、年龄>45岁、病程>6周这三个因素为影响创伤后重度肘关节僵硬近期疗效的独立危险因素。结论创伤后重度肘关节僵硬的近期疗效存在一定局限性。在创伤后重度肘关节僵硬患者的康复过程中对于中老年肘关节复杂性损伤患者尤其要注意早期的(6周内)干预。Background The elbow joint is a highly restricted hinge joint.Among all the joints,the elbow is the most prone to post-traumatic stiffness.It is reported that the incidence of elbow stiffness after trauma is about 16%-40%,and the risk of elbow joint stiffness after trauma ranks first among all joint traumas.The severity of limitation of flexion and extension is classified according to Morrey's elbow stiffness classification,including extremely severe(ranges of elbow joint flexion and extension≤30°),severe(ranges of elbow joint flexion and extension>30°but≤60°),moderate(ranges of elbow joint>60°but<90°),and mild(ranges of elbow flexion and extension≥90°but≤100°).Comprehensive conservative treatment is recommended to treat post-traumatic elbow stiffness of fewer than 6 months without bone structure problem.Currently,rehabilitation treatment mainly includes functional exercises,stretching braces,shortwave,ultrasound therapy,internal and external application of Chinese medicine,massage,manual massage,and drug fumigation.There is a big difference in the efficacy of conservative treatment for different degrees of post-traumatic elbow stiffness,which is related to the original diagnosis,violence,surgical conditions,and immobilization duration.The greater the degree of stiffness,the relatively poorer the conservative treatment effect.At present,no report has been retrieved for the analysis of rehabilitation effects for patients with different degrees of elbow stiffness.Objective To observe the short-term efficacy of comprehensive rehabilitation for severe post-traumatic elbow stiffness(range of motion≤60°)and analyze the related factors.Methods A retrospective study was conducted on the inpatients in our department from January 2017 to December 2020.All the patients were treated with a comprehensive rehabilitation program of traditional Chinese and western medicine,including joint loosening maneuver,static stretching brace therapy,active exercise therapy,cold therapy,and Chinese medicine external applic

关 键 词：创伤性肘关节僵硬 康复治疗 近期疗效 影响因素 

分 类 号：R687.4[医药卫生—骨科学]