关节活动训练系统治疗深度烧伤后关节功能障碍的临床效果

Clinical effects of Joint Active System on the treatment of joint dysfunction after deep burn

目的观察关节活动训练系统的应用对深度烧伤后关节功能障碍的临床治疗效果。方法2015年1月—2016年10月，武汉大学同仁医院暨武汉市第三医院烧伤研究所收治深度烧伤后关节功能障碍患者22例，其中18个肘关节屈曲障碍、10个腕关节背伸障碍、12个踝关节背伸障碍，分别采用关节活动训练系统中的肘关节活动训练器、腕关节活动训练器、踝关节活动训练器治疗，每天治疗3次（间隔6 h），每次30 min，1个月为一个疗程，治疗4～7个月。分别于治疗前及治疗1、2、3、4个月，采用关节角度尺测量各关节主动活动度；治疗4个月，评估各关节功能改善情况并计算总有效比；治疗1、2、3、4个月，应用改良李克特量表评估患者满意度。对数据行单组重复测量方差分析、LSD检验。结果治疗前及治疗1、2、3、4个月，肘关节屈曲主动活动度分别为（61±23）、（78±22）、（89±20）、（96±20）、（103±19）°，腕关节背伸主动活动度分别为（23±7）、（31±6）、（38±9）、（44±5）、（49±8）°，踝关节背伸主动活动度分别为（－31±12）、（－23±10）、（－16±7）、（－12±6）、（－8±4）°，与各关节中前一时相点比较，各关节治疗1、2、3、4个月主动活动度均明显增加（P值均小于0.01）。治疗4个月，肘关节、腕关节、踝关节功能改善总有效比分别为5/6、9/10、2/3。治疗1、2、3、4个月，患者满意度评分分别为（1.3±0.7）、（2.2±1.0）、（2.8±0.8）、（3.3±0.6）分。与前一时相点比较，治疗2、3、4个月患者满意度评分均明显增加（P值均小于0.05）。结论关节活动训练系统治疗深度烧伤后关节功能障碍，可明显改善各关节主动活动度，关节功能改善总有效比达到0.66以上，大部分患者对治疗效果表示比较满意。

ObjectiveTo observe the clinical effects of the Joint Active System on the treatment of joint dysfunction after deep burn. MethodsTwenty-two patients with joint dysfunction after deep burn were hospitalized in Institute of Burns of Tongren Hospital of Wuhan University ＆ Wuhan Third Hospital from January 2015 to October 2016, involving 18 elbow joints with flexion disorder, 10 wrist joints with dorsal extension disorder, and 12 ankle joints with dorsal extension disorder. They were treated with the elbow joint activity training device, the wrist joint activity training device, and the ankle joint activity training device of the Joint Active System, respectively. The treatment was carried out 3 times each day with interval of 6 h, 30 minutes each time, and it lasted for four to seven months, with one month as a course of treatment. Before treatment and 1, 2, 3, 4 month （s） after, active motion range of each joint was measured by joint goniometer. Function improvement of each joint was evaluated, and the total effective ratio was calculated 4 months after treatment. Satisfaction degree of patients was assessed by the modified Likert Scale 1, 2, 3, 4 month （s） after treatment. Data were processed with one-way analysis of variance for repeated measurement and LSD test. ResultsBefore treatment and 1, 2, 3, 4 month （s） after, flexion active motion range of elbow joints were （61±23）, （78±22）, （89±20）, （96±20）, and （103±19）°; dorsal extension active motion range of wrist joints were （23±7）, （31±6）, （38±9）, （44±5）, and （49±8）°; dorsal extension active motion range of ankle joints were （-31±12）, （-23±10）, （-16±7）, （-12±6）, and （-8±4）°, respectively. The active motion range of each joint was obviously higher 1, 2, 3, 4 month （s） after treatment than the previous time point of the same joint （with P values below 0.01）. Four months after treatment, the total effective ratios of function improvement of elbow joints, wrist joints, and ankle joints were 5/6, 9/10, and 2/3, respectively. Scores of satisfaction degree of the patients 1, 2, 3, 4 month （s） after treatment were （1.3±0.7）, （2.2±1.0）, （2.8±0.8）, and （3.3±0.6） points, respectively. Scores of satisfaction degree of the patients were obviously higher 2, 3, 4 months after treatment than the previous time point （with P values below 0.05）. ConclusionsJoint Active System can improve the active range of motion of each joint obviously in treating joint dysfunction after deep burn, with total effective ratio of function improvement of each joint surpassing 0.66, and the majority of patients are quite satisfied with the curative effects.