早期康复治疗对手部瘢痕挛缩患者术后手功能的影响

Effect of Early Rehabilitation Treatment on Postoperative Hand Function in Patients with Hand Scar Contracture

目的 探讨早期康复治疗对手部瘢痕挛缩患者术后手功能影响。方法 采用回顾性非随机对照的研究方法,选取2019年9月至2022年3月于郑州大学第一附属医院烧伤与修复重建外科收治的60例手部瘢痕挛缩伴功能障碍患者的临床资料,瘢痕挛缩时间3~12个月,其中男32例,女28例,年龄6~30岁。根据患者是否在术后1个月内进行手部康复功能锻炼分为早期康复组(≤1个月)和晚期康复组(>1个月)。所有患者接受相同的康复内容,包括瘢痕皮肤护理,外用防疤药物,瘢痕按摩,主、被动关节活动,压力治疗,支具佩戴等。嘱患者及家属分别于术后3、6个月来院复查。对比两组患者基本资料和切口愈合时间,采用温哥华瘢痕量表(VSS)评估患者术前及术后3、6个月手部瘢痕增生情况;采用Jebsen手功能测试评估患者治疗前及术后3、6个月的手功能变化;采用总主动活动度法评定手指关节活动度,并计算优良比;记录两组患者术后不良反应发生情况。结果 术前两组手部瘢痕评分、完成Jebsen手功能测试所需时间比较,差异无统计学意义(P>0.05),术后3、6个月,早期康复组手部瘢痕评分均低于晚期康复组,完成Jebsen手功能测试所需时间均短于晚期康复组(P<0.05)。术前早期康复组和晚期康复组手关节活动度优良比分别为4/30、5/30,术后3个月优良比分别为28/30、22/30;术后6个月优良比分别为29/30、23/30,术后3、6个月,早期康复组手关节活动度优良比高于晚期康复组(P<0.05);两组治疗期间均未出现皮片坏死、感染、水疱等不良反应。结论 早期康复治疗能改善手瘢痕增生情况,增加相关受累关节活动范围,能较好恢复手功能,从而提高患者的生活质量。

Objective To investigate the effect of early rehabilitation treatment on postoperative hand function in patients with hand scar contracture.Methods A retrospective non-randomized controlled study was used to study the clinical data of 60 patients with hand scar deformities admitted to the First Affiliated Hospital of Zhengzhou University from September 2019 to March 2022 in the Department of Burn Repair and Reconstructive Surgery.Scar contracture lasted for 3-12 months,with 32 males and 28 females aged from 6 to 30 years old.Patients were divided into early rehabilitation group(≤1 month)and late rehabilitation group(>1 month)according to whether the patients performed hand rehabilitation function exercise within 1 month after the incision.All patients received the same rehabilitation content,including scar skin care,topical anti-scar drugs,scars massage,active and passive joint activities,pressure therapy,orthosis wearing.The patients and their families were asked to come to the hospital for reexamination 3 and 6 months after the operation.The basic information and wound healing time of the two groups were compared.The Vancouver scar scale(VSS)was used to evaluate the hand scar hyperplasia of the patients before operation,3 and 6 months after operation.Jebsen hand function test was used to evaluate the changes in hand function of patients before treatment,3 and 6 months after surgery.The total active range of motion method was used to evaluate finger joint range of motion,and the excellent ratio was calculated.The incidence of postoperative adverse reactions in the two groups was recorded.Results The hand scar scores and the time required to complete the Jebsen hand function test of the two groups were not statistically significant(P>0.05).At 3 and 6 months after surgery,the hand scar scores in the early rehabilitation group were lower than those in the late rehabilitation group,and the time required to complete the Jebsen hand function test were shorter than those in the late rehabilitation group(P<0.05).The excellent ratio of the hand joint range of motion in the early rehabilitation group and late rehabilitation group before operation were 4/30 and 5/30,respectively,and the excellent ratio after 3 months of treatment were 28/30 and 22/30,respectively,the excellent ratio after 6 months of treatment were 29/30,23/30,respectively.The excellent ratio of mobility of hand joints in the early rehabilitation group was higher than that in the late rehabilitation group after 3 and 6 months of treatment(P<0.05).There was no skin necrosis,infection,blisters and other adverse reactions occurred in the two groups during the treatment.Conclusion Early rehabilitation treatment can improve hand scar hyperplasia,increase the range of motion of affected joints,and better restore hand function,thereby improving the quality of life of patients.