挤压伤残留屈屈趾畸形的综合康复治疗
摘要
目的探讨地震挤压伤患者后期残留屈屈趾畸形的综合康复治疗效果,寻求最佳治疗方案。方法对筛选的40例残留有屈屈趾畸形的挤压伤伤员采取物理疗法、功能训练、手法治疗等综合康复方法,康复治疗无效者给予长屈肌腱、趾屈总肌腱松解、延长术或远端切断术,术后用相应综合康复方案早期介入。长期随访观察40例伤员的脚趾功能恢复情况,根据Maryland足部评分标准对其疗效进行评定。结果所有病例均获随访,随访时间6～12个月,平均9个月。40例伤员均取得了满意的治疗效果,脚趾的屈曲伸展功能明显改善,行走功能恢复正常。按照Maryland足部评分标准:非手术组由治疗前的(54.0±7.3)分上升至6个月后的(83.78±10.9)分、12个月后的(89.5±7.5)分,P<0.01;手术干预组由治疗前的(48.2±2.6)分上升至6个月后的(51.1±3.8)分、12个月后的(89.9±5.7)分,P<0.01。优30例,良8例,可2例,差0例,总体优良率为95%。结论由于地震伤的特殊性,挤压伤后期可能残留不同程度的肢体功能障碍,应当重视长期观察伤员的肢体功能情况,综合康复方案和必要的手术干预对治疗挤压伤残留屈屈趾畸形的患者疗效显著。
引文
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[2]O′Sullivan E,Carare-Nnadi R,Greenslade J,et al.Clinical significance of variations in the interconnec-tions between flexor digitorum longus and flexor hal-lucis longus in the region of the knot of Henry[J].Clin Anat,2005,18(2):121-125.
[3]Boruta PM,Beauperthuy GD.Partial tear of the flex-or hallucis longus at the knot of Henry:presentationof three cases[J].Foot Ankle Int,1997,18(4):243-246.
[4]Takakura Y,Yajima H,Tanaka Y,et al.Treatmentof extrinsic flexion deformity of the toes associatedwith previous removal of a vascularized fibular graft[J].J Bone Joint Surg(Am),2000,82(1):58-61.
[5]Leitschuh PH,Zimmerman JP,Uhorchak JM,et al.Hallux flexion deformity secondary to entrapment ofthe flexor hallucis longus tendon after fibular frac-ture[J].Foot Ankle Int,1995,16(4):232-235.
[6]刘津浩,徐向阳.腓骨骨折术后并发足母趾屈曲畸形的治疗[J].中华骨科杂志,2006,26(9):594-597.
[7]张国柱,蒋协远.踝关节骨折内固定术后出现足母趾屈曲畸形的临床分析[J].北京医学,2006,28(3):165-167.
[8]胥少汀,葛宝丰,徐印坎.实用骨科学[M].第3版.北京:人民军医出版社,2005:318-328.
[9]吴阶平,裘法祖,黄家驷.外科学(下册)[M].第6版.北京:人民卫生出版社,1999:2052-2056.
[10]南登昆.康复医学[M].第3版.北京:人民卫生出版社,2005:135-159.
[11]蒋协远,王大伟.骨科临床疗效评价标准[M].北京:人民卫生出版社,2005:241-243.
[12]赵振彪,彭彦辉.骨科康复医学[M].石家庄:河北科学技术出版社,2008:216-219.
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