综合康复在汶川地震截肢伤员功能障碍的临床疗效分析
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摘要
目的观察综合康复治疗对汶川地震截肢伤员功能障碍的临床疗效。方法对5·12汶川大地震22例挤压伤截肢患者的24条截肢残端实施护理、摆放良肢位、运动治疗、残端塑形、紫外线疗法、红外线疗法、石蜡疗法、音频电疗法、经皮电刺激神经疗法、关节松动、按摩和拍打、超短波治疗、作业疗法和心理治疗等综合康复治疗,直至截肢伤员出院为止。视觉模拟评分法量表评定幻肢痛疼痛强度、测定膝关节和髋关节活动范围、Barthel指数评定日常活动。结果治疗前幻肢痛疼痛强度为2.95±1.33,治疗后为0.50±0.96;治疗前肘关节活动范围为(90.0±28.3)°,治疗后为(135.0±7.1)°;治疗前肩关节屈伸活动范围为(68.8±27.8°),治疗后为(137.5±9.6)°;治疗前肩关节收展活动范围为(53.8±7.5)°,治疗后为(96.3±4.8)°;治疗前膝关节活动范围为(91.0±23.0)°,治疗后为(123.0±6.7)°;治疗前髋关节屈伸活动范围为(86.9±25.9)°,治疗后为(132.3±13.8)°;治疗前髋关节收展活动范围为(46.9±10.9)°,治疗后为(64.6±8.7)°;治疗前Barthel指数为57.05±18.69,治疗后为78.18±13.85,康复治疗前后均有统计学意义(P<0.05)。结论地震后截肢不良残肢发生率高,综合康复治疗能促进截肢残端伤口愈合和消除残肢疼痛,可明显改善残肢条件,有利于地震截肢患者功能恢复和日常生活能力的提高,为后期的假肢安装及步态训练创造了条件。
Objective To observe the efficiency of comprehensive rehabilitation therapy on amputation patients after Wenchuan earthquake.Methods Twenty-two amputation patients after Wenchuan earthquake with 24stumps were treated with postoperative wound care,maintaining the correct position of the limbs,exercise therapy,stump shaping,ultraviolet therapy,infrared therapy,paraffin therapy,audio electrotherapy,transcutaneous electrical nerve stimulation therapy,joint mobilization,massage,beat,ultrashort wave therapy,occupational therapy and psychotherapy and so on until discharged.The results were measured from the following aspects:pain intensity using VAS,rangement of knee joint and hip joint,Barthel index of ADL before and after rehabilitation.Results Pain intensity of phantom limb pain were(2.94±1.53)before rehabilitation,and(0.44±1.03)after;the movement range of elbow was(90.0±28.3)°before and(135.0±7.1)°after;the movement range of shoulder flexion and extension was (68.8±27.8)°before and(137.5±9.6)°after;the movement range of shoulder abduction and adduction was(53.8± 7.5)°before and(96.3±4.8)°after rehabilitaion;the movement range of knee was(91.0±23.0)°before and (123.0±6.7)°after rahabiliation;the movement range of hip flexion and extension was(86.9±25.9)°before and (132.3±13.8)°after;the movement range of hip abduction and adduction was(46.9±10.9)°before and(64.6± 8.7)°after;the score of Barthel index was 57.05±18.69before and 78.18±13.85after.The difference between be-fore and after rehabilitation were statistically significant(P<0.05).Conclusion The incidence of adverse amputation stumps after the earthquake was high.Integrative rehabilitation has an positive effect on promoting wound healing,by eliminating stump pain and recovering lower limb function,improving daily living function and social ability,and crea-ting conditions for installing prosthesis limbs and gait training in later period.
Objective To observe the efficiency of comprehensive rehabilitation therapy on amputation patients after Wenchuan earthquake.Methods Twenty-two amputation patients after Wenchuan earthquake with 24stumps were treated with postoperative wound care,maintaining the correct position of the limbs,exercise therapy,stump shaping,ultraviolet therapy,infrared therapy,paraffin therapy,audio electrotherapy,transcutaneous electrical nerve stimulation therapy,joint mobilization,massage,beat,ultrashort wave therapy,occupational therapy and psychotherapy and so on until discharged.The results were measured from the following aspects:pain intensity using VAS,rangement of knee joint and hip joint,Barthel index of ADL before and after rehabilitation.Results Pain intensity of phantom limb pain were(2.94±1.53)before rehabilitation,and(0.44±1.03)after;the movement range of elbow was(90.0±28.3)°before and(135.0±7.1)°after;the movement range of shoulder flexion and extension was (68.8±27.8)°before and(137.5±9.6)°after;the movement range of shoulder abduction and adduction was(53.8± 7.5)°before and(96.3±4.8)°after rehabilitaion;the movement range of knee was(91.0±23.0)°before and (123.0±6.7)°after rahabiliation;the movement range of hip flexion and extension was(86.9±25.9)°before and (132.3±13.8)°after;the movement range of hip abduction and adduction was(46.9±10.9)°before and(64.6± 8.7)°after;the score of Barthel index was 57.05±18.69before and 78.18±13.85after.The difference between be-fore and after rehabilitation were statistically significant(P<0.05).Conclusion The incidence of adverse amputation stumps after the earthquake was high.Integrative rehabilitation has an positive effect on promoting wound healing,by eliminating stump pain and recovering lower limb function,improving daily living function and social ability,and crea-ting conditions for installing prosthesis limbs and gait training in later period.
引文
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[4]Halbert J,Crotty M,Camemn ID.Evidence for the optimal man-agement of acute and chronic phantom pain:a systematic review[J].Clin J Pain,2002,18(2):84-92.
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[7]Hill A.Phantom limb pain:a review of literature on attributes and potential mechanisms[J].J Pain Symptom Manage,1999,17(2):125-142.
[8]钱红,黄勇,朱守政.早期介入作业疗法对急性脑卒中偏瘫患者上肢运动功能及ADL能力的影响[J].中国康复医学杂志,2007,22(4):343-344.
[9]闫彦宁,贾子善,王丽春.在综合医院实施作业治疗初探[J].中国康复医学杂志,2006,21(1):77-78.
[2]胡必杰,陶黎黎.地震灾害伤员的常见感染类型和预治对策[J],中华医院感染学杂志,2008,18(6):3-5.
[3]张庆江.地震灾害紧急医疗救援的难点及对策探讨[J],武警医学,2006,17(10):788-789.
[4]Halbert J,Crotty M,Camemn ID.Evidence for the optimal man-agement of acute and chronic phantom pain:a systematic review[J].Clin J Pain,2002,18(2):84-92.
[5]Mortimer CM,Steedman WM,McMillan IR,et al.Patient in-formation on phantom limb pain:a focus group study of patient experiences,perceptions and opinions[J].Health Educ Res,2002,17(3):291-304.
[6]Whyte AS,Niven CA.Psychological distress in amputees with phantom limb pain[J].J Pain Symptom Manage,2001,22(5):938-946.
[7]Hill A.Phantom limb pain:a review of literature on attributes and potential mechanisms[J].J Pain Symptom Manage,1999,17(2):125-142.
[8]钱红,黄勇,朱守政.早期介入作业疗法对急性脑卒中偏瘫患者上肢运动功能及ADL能力的影响[J].中国康复医学杂志,2007,22(4):343-344.
[9]闫彦宁,贾子善,王丽春.在综合医院实施作业治疗初探[J].中国康复医学杂志,2006,21(1):77-78.
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