自制静态渐进性支具阶梯式治疗烧伤后瘢痕挛缩致手屈曲功能障碍的效果  

Effect of self-made static progressive braces in the stepwise treatment of hand flexion dysfunction caused by scar contracture after burn injury

作　　者：赵海洋 周琴 刘佳琦 张万福 朱婵 徐婧 韩军涛 胡大海 官浩 Zhao Haiyang;Zhou Qin;Liu Jiaqi;Zhang Wanfu;Zhu Chan;Xu Jing;Han Juntao;Hu Dahai;Guan Hao(Department of Burns and Cutaneous Surgery,Burn Center of PLA,the First Affiliated Hospital of Air Force Medical University,Xi'an 710032,China)

机构地区：[1]空军军医大学第一附属医院全军烧伤中心,烧伤与皮肤外科,西安710032

出　　处：《中华烧伤与创面修复杂志》2025年第2期155-162,共8页Chinese Journal of Burns And Wounds

基　　金：国家自然科学基金面上项目(82272268);陕西省重点研发计划(2023-YBSF-578);军队护理创新与培育专项计划(2023HL046)。

摘　　要：目的 探讨自制静态渐进性支具阶梯式治疗烧伤后瘢痕挛缩致手屈曲功能障碍的效果。方法 该研究为回顾性观察性研究。2022年1月-2024年3月,空军军医大学第一附属医院收治29例符合入选标准的采用自制静态渐进性支具阶梯式治疗瘢痕挛缩致手屈曲功能障碍的患者,其中男23例、女6例,年龄16-55岁,手背部烧伤深度为深Ⅱ~Ⅲ度。自制静态渐进性支具指自制静态渐进性关节牵伸器和自制静态渐进性手屈曲牵伸器。阶梯式治疗的第1个阶段选择在院治疗2~4周,治疗内容包括行常规康复训练和应用自制静态渐进性关节牵伸器训练。待掌指关节主动屈曲活动范围≥60°后,则可进阶到第2个阶段,即为期2周的居家远程康复治疗,治疗内容包括行自制静态渐进性关节牵伸器训练、自制静态渐进性手屈曲牵伸器训练等个体化运动训练。记录阶梯式治疗期间是否发生水疱、支具卡压、组织拉伤等不良事件。阶梯式治疗结束后,观察患手主动屈曲情况。随访时,测量患手总主动活动度,评估患手背部瘢痕及皮肤软组织延展性情况以及患者对疗效的满意度。末次随访时,参照中华医学会手外科学会上肢部分功能评定试用标准评价患手功能。结果 在阶梯式治疗期间,2例患者腕关节处皮肤产生少许水疱,经对症处理后痊愈;其余患者未出现支具卡压、组织拉伤等不良事件。阶梯式治疗结束后,患手主动屈曲功能较佳,可基本握拳。随访1~3个月,患手总主动活动度为200-245°;手背部瘢痕质地较软、色泽较浅,皮肤软组织延展性良好;对疗效非常满意者22例、满意者6例、不满意者1例。末次随访时,患手功能评定为优者20例、良者9例。结论 采用自制静态渐进性支具阶梯式治疗烧伤后瘢痕挛缩致手屈曲功能障碍的效果佳,并发症少;且2种自制静态渐进性牵伸器的取材方便、制作简单、经济有效�ObjectiveTo explore the effect of self-made static progressive braces in the stepwise treatment of hand flexion dysfunction caused by scar contracture after burn injury.MethodsThis study was a retrospective observational study.From January 2022 to March 2024,the First Affiliated Hospital of Air Force Medical University admitted twenty-nine patients who met the inclusion criteria and used the self-made static progressive braces for stepwise treatment of hand flexion dysfunction caused by scar contracture,including 23 males and 6 females,aged 16 to 55 years.The depth of burn on the back of the hand was deep partial-thickness to full-thickness.The self-made static progressive brace referred to the self-made static progressive joint distractor and the self-made static progressive hand flexion distractor.The stepwise treatment was adopted.In the first stage,in-hospital treatment for 2 to 4 weeks was selected.The treatment contents included conventional rehabilitation training and training on the application of the self-made joint distractors.When the active flexion range of motion of the metacarpophalangeal joint was≥60°,the second stage of treatment was carried out,that is,two weeks of home remote rehabilitation treatment.The treatment contents included individualized exercise training such as training with self-made static progressive joint distractors and training with self-made static progressive hand flexion distractors.Adverse events such as blister,brace compression,and tissue strain during the stepwise treatment were recorded.After the end of the stepwise treatment,the active flexion of the affected hand was observed.During follow-up,the total active range of motion of the affected hand was measured,and the extensibility of the scar and skin and soft tissue on the back of the affected hand and the patient's satisfaction with the therapeutic effect were evaluated.At the last follow-up,the function of the affected hand was evaluated according to the trial standards for evaluation of partial function of upper

关 键 词：烧伤 康复 设备设计 爪形手 静态渐进性牵伸技术 

分 类 号：R47[医药卫生—护理学]