早期康复训练结合综合物理干预对创伤性周围神经损伤后手功能障碍的影响

Effect of early rehabilitation training combined with comprehensive physical therapy on hand dysfunction after traumatic peripheral nerve injury

目的探讨早期康复训练结合综合物理干预对创伤性周围神经损伤后手功能障碍的影响。方法选取2018年1月~2019年4月沈阳医学院附属中心医院收治的80例外伤性周围神经损伤所致手部功能障碍患者作为研究对象,按照随机数字表法将其分为对照组与观察组,每组各40例。对照组患者行早期的被动手术功能锻炼,观察组患者实施早期康复训练结合综合物理干预。比较两组患者的上肢主要滋养血管血流峰值情况、正中神经电生理指标以及干预后1年两组患者的临床症状、手部功能评分变化情况。结果干预后,观察组患者的肱动脉及腋动脉血流峰值均高于对照组,差异有统计学意义(P<0.05)。干预后,观察组患者的感觉及运动神经传导速度均高于对照组,差异有统计学意义(P<0.05)。干预后1年,观察组患者肢体麻木、关节僵硬、慢性疼痛及肢体萎缩发生率均低于对照组,差异有统计学意义(P<0.05)。干预后3个月及干预后1年,观察组患者的手部功能评分均高于对照组,差异有统计学意义(P<0.05)。结论针对创伤性周围神经损伤所致手部功能障碍,实施早期康复治疗结合综合物理干预可显著改善手术血液循环及神经传导,减少中远期并发症,提高手部功能。

Objective To explore the effect of early rehabilitation training combined with comprehensive physical therapy on hand dysfunction after traumatic peripheral nerve injury.Methods A total of 80 patients with hand dysfunction caused by traumatic peripheral nerve injury admitted to Central Hospital Affiliated to Shenyang Medical College from January 2018 to April 2019 were selected as the research objects and divided into the control group and the observation group according to the random number table method,with 40 cases in each group.The control group received early passive surgical functional exercise,while the observation group received early functional rehabilitation training combined with physical therapy.The peak blood flow of main nutrient vessels in upper limbs,the median nerve sensory and motor nerve conduction velocity,clinical symptoms after follow-up for 1 year and the changes of hand function scores during the intervention were compared between the two groups.Results The peak blood flow of brachial artery and axillary artery in the observation group after intervention were higher than those in the control group,and differences were statistically significant(P<0.05).The median nerve sensory and motor nerve conduction velocity in the observation group after intervention were higher than those in the control group,and differences were statistically significant(P<0.05).The incidence rates of limb numbness,joint stiffness,chronic pain and limb atrophy in the observation group after 1 year follow-up were lower than those in the control group,and differences were statistically significant(P<0.05).The hand function scores in the observation group at three months after intervention and one year after intervention were higher than those in the control group,and differences were statistically significant(P<0.05).Conclusion For hand dysfunction caused by traumatic peripheral nerve injury,early rehabilitation therapy combined with comprehensive physical intervention can significantly improve blood circulation and nerve conduction during surgery,reduce mid-term and long-term complications and improve hand function.