双向牵引渐进性屈指支具在掌指关节周围骨折术后早期康复治疗中的应用  

Application of bi-directional traction progressive flexion brace in early postoperative rehabilitation treatment of metacarpophalangeal joint fractures

作　　者：苏栩蓓 印飞 施海峰 王骏 曾蕾 范嘉琪 芮永军 Su Xubei;Yin Fei;Shi Haifeng;Wang Jun;Zeng Lei;Fan Jiaqi;Rui Yongjun(Suzhou Medical College,Suzhou University,Suzhou 215123,China;Department of Orthopedics,Wuxi Ninth People's Hospital,Wuxi 214062,China;Department of Rehabilitation Medicine,Wuxi Ninth People's Hospital,Wuxi214062,China)

机构地区：[1]苏州大学苏州医学院,苏州215123 [2]无锡市第九人民医院骨科,无锡214062 [3]无锡市第九人民医院康复医学科,无锡214062

出　　处：《中华手外科杂志》2024年第6期533-537,共5页Chinese Journal of Hand Surgery

基　　金：无锡市“太湖人才计划”顶尖医学团队课题。

摘　　要：目的探讨双向牵引渐进性屈指支具在掌指关节周围骨折患者术后早期康复治疗中的应用效果。方法本研究共纳人自2022年1月至2022年12月我院治疗的36例掌指关节周围骨折患者,其中掌骨头骨折18指、掌骨颈骨折8例、近节指骨基底骨折10例。所有患者术后第5周开始行康复治疗结合双向牵引渐进性屈指支具辅助下轴向牵引,术后6周行康复治疗结合双向牵引渐进性屈指支具双向牵引。比较患者治疗前、治疗后2、4周掌指关节被动活动角度(passiverange of motion,PROM)、主动活动角度(active range of motion,AROM)、指根部周径、握力、视觉模拟评分(visual analogue scale,VAS)、臂、肩、手功能障碍(disabilites of thearm,shoulder,and hand,DASH)评分等指标。结果所有患者均完成4周的治疗,治疗前患指掌指关节的PROM为(27.3±6.7)、AROM为(12.6±13.3)°,指根部周径(8.5±0.1)cm,握力(9.2±1.5)N,VAS(4.3±1.2),DASH评分(51.2±7.3)分;经过双向牵引渐进性屈指支具结合早期康复干预治疗后2、4周所有患者各项指标均获得明显改善,治疗后4周掌指关节主被动活动度、握力基本恢复正常,组间比较差异均有统计学意义(P<0.05)。结论双向牵引渐进性屈指支具结合早期康复干预治疗掌指关节周围骨折疗效显著,通过改善手指肿胀、提升关节囊趋顺性、增加软组织的蠕变与应力松弛来促进掌指关节功能的早期恢复,疼痛感低、治疗过程更舒适,值得临床推广。Objective To investigate the application efficacy of bi-directional traction progressive flexion brace in early postoperative rehabilitation treatment of metacarpophalangeal joint fractures.Methods From January 2022 to December 2022,a total of 36 patients with fractures around the metacarpophalangeal joint,including 18 cases of metacarpal head fractures,8 cases of metacarpal neck fractures,and 10 cases of proximal phalangeal base fractures.Starting from the 5th week after surgery,all patients received rehabilitation treatment combined with bidirectional traction progressive flexion brace assisted axial traction.At the 6th week after surgery,rehabilitation treatment combined with bidirectional traction progressive flexion brace assisted bidirectional traction was performed.The passive range of motion(PROM),active range of motion(AROM),finger root circumference,grip strength,visual analogue scale(VAS),arm,shoulder,and hand dysfunction(DASH)scores of patients before and 2 or 4 weeks after treatment were compared.Results All patients completed 4 weeks of treatment.Prior to treatment,the PROM and AROM of the affected metacarpophalangeal joint were(27.3±6.7)°and(12.6±13.3)°,with finger root circumference of(8.5±0.1)cm,grip strength of(9.2±1.5)N,VAS of(4.3±1.2)points,and DASH score of(51.2±7.3)points.After bi-directional traction progressive flexion brace combined with early rehabilitation intervention,all patients achieved significant improvement in various indicators at 2 and 4 weeks.After 4 weeks of treatment,the active and passive range of motion and grip strength of the metacarpophalangeal joint basically returned to normal,and the differences between groups were statistically significant(P<0.05).ConclusionThe combination of bi-directional traction progressive flexion brace and early rehabilitation intervention has a significant therapeutic effect on fractures around the metacarpophalangeal joint.It promotes early recovery of metacarpophalangeal joint function by improving finger swelling,enhancing joint ca

关 键 词：掌指关节 骨折 牵引 早期康复 支具 

分 类 号：R687.3[医药卫生—骨科学]