运动疗法联合自制简易矫形器治疗儿童手部烧伤瘢痕挛缩的疗效观察

Curative effects of kinesitherapy in combination with self-made simple orthosis in treatment of scar contracture of burned hand in children

目的 观察运动疗法联合自制简易矫形器治疗儿童手部烧伤后瘢痕挛缩的疗效.方法 2012年1月-2014年1月,选择在笔者单位康复中心治疗的58例伴单侧手部烧伤患儿,按随机数字表法分为简易矫形器组和常规康复组,每组29例.自创面愈合后,简易矫形器组患儿采取运动疗法配合手部游戏锻炼及佩戴自制简易矫形器（由分指蹼带、自粘弹力绷带、手部输液固定板等组成）治疗,常规康复组患儿行运动疗法配合手部游戏锻炼及佩戴成品压力手套.治疗前及治疗16周后,采用温哥华瘢痕量表评定瘢痕情况,采用Jebsen手功能测试法评定手功能并记录完成测试时间,采用改良Barthel指数评定日常生活活动能力;治疗16周后采用总主动活动度（TAM）法评定关节活动度.对数据行t检验、x2检验. 结果 简易矫形器组患儿瘢痕情况评分治疗前为（12.2±1.3）分,治疗16周后为（6.7±2.2）分,改善分值（5.6±1.8）分;常规康复组患儿瘢痕情况评分治疗前为（12.0±1.4）分,治疗16周后为（7.0±1.8）分,改善分值（5.0±1.0）分.2组患儿瘢痕改善分值差异不明显（t=1.452,P=0.152）.简易矫形器组患儿TAM评定优良比75.9％（22/29）,常规康复组患儿TAM评定优良比37.9％（11/29）,差异明显（t=8.507,P=0.004）.简易矫形器组患儿完成手功能测试时间治疗前为（8.2±1.6）min,治疗16周后为（7.1±1.4）min,改善时间为（1.2±1.5）min;常规康复组患儿完成手功能测试时间治疗前为（9.0±1.9）min,治疗16周后为（6.3±1.4） min,改善时间为（2.7±2.7）min.2组患儿手功能测试改善时间差异明显（t=2.618,P=0.012）.简易矫形器组患儿日常生活活动能力评分治疗前为（7.7±1.4）分,治疗16周后为（10.4±1.4）分,改善分值为（2.7±1.7）分;常规康复组患儿日常生活活动能力评分治疗前为（7.8±1.4）分,治疗16周后为（9.5±1.4）分,改善分值为（1.7±1.6）分.2组患儿日常生活活动能力改善分值差异明显（t=2.246,P=0.029）. 结论 简易矫形器结合运动疗法,有利于烧伤患儿手部功能的恢复及防治手部挛缩畸形,值得推广应用.

Objective To survey the curative effects of kinesitherapy in combination with self-made simple orthosis （SO） in treatment of scar contracture of burned hand in children.Methods Fifty-eight children with burns of unilateral hand and received treatment in our rehabilitation center from January 2012 to January 2014 were divided into common rehabilitation （CR） and SO groups according to the random number table,with 29 cases in each group.After the wounds were healed,patients in group CR were treated with kinesitherapy combined with hand game exercises and pressure gloves,while patients in group SO were treated with kinesitherapy combined with hand game exercises and self-made SO,which was composed of finger web dividing belt,self-adhesive bandage,and infusion set fixing plate.Before treatment and 16 weeks after treatment,scar condition was assessed with the Vancouver Scar Scale （VSS） ; hand function was evaluated by the Jebsen Test of Hand Function,and the completion time was recorded ; and the activities of daily life （ADL） was measured by the modified Barthel Index.Sixteen weeks after treatment,the range of motion was measured with the Total Active Movement （TAM） method.Data were processed with t test and chisquare test.Results The score of VSS in group SO was （12.2 ± 1.3） points before treatment and （6.7 ± 2.2） points 16 weeks after treatment,and the improvement score was （5.6 ± 1.8） points.The score of VSS in group CR was （12.0 ± 1.4） points before treatment and （7.0 ± 1.8） points 16 weeks after treatment,and the improvement score was （5.0 ± 1.0） points.There was no obvious difference in improvement score of VSS between the two groups （t =1.452,P =0.152）.The ratio of excellent and good results according to TAM method in group SO was 75.9% （22/29）,while it was 37.9% （11/29） in group CR （t =8.507,P =0.004）.The completion time for the Jebsen Test of group OS was （8.2 ± 1.6） min before treatment and （7.1 ± 1.4） min after treatment,and the improvement time was （1.2 ± 1.5） min.The completion time for the Jebsen Test of group CR was （9.0 ± 1.9） min before treatment and （6.3 ± 1.4） min 16 weeks after treatment,and the improvement time was （2.7 ± 2.7） min.There was a significant difference in improvement time for the Jebsen Test between the two groups （t =2.618,P =0.012）.The score of ADL in group CR was （7.7 ± 1.4） points before treatment and （10.4 ± 1.4） points 16 weeks after treatment,and the improvement score was （2.7 ± 1.7） points.The score of ADL in group CR was （7.8 ± 1.4） points before treatment and （9.5 ± 1.4） points 16 weeks after treatment,and the improvement score was （1.7 ± 1.6） points.There was a significant difference in improvement score of ADL between the two groups （t =2.246,P =0.029）.Conclusions Kinesitherapy in combination with self-made SO can improve the functional recovery of burned hand in children and prevent contractures in hand,and it is worth applying generally.