Zhu C, Yi N, Shi M N, Liang Y Y, Zhou Y B, Dang R, Qi Z S, Zhao H Y
Burn Center of PLA, Department of Burns and Cutaneous Surgery, Xijing Hospital, the Fourth Military Medical University, Xi'an 710032, China.
Zhonghua Shao Shang Za Zhi. 2017 Jul 20;33(7):426-430. doi: 10.3760/cma.j.issn.1009-2587.2017.07.007.
To observe the effects of functional training combined with self-made hand flexing training band in treatment of scar contracture after burn injury of dorsal hand. Forty-six patients with scar contracture after deep partial-thickness or full-thickness burn injury of dorsal hand hospitalized in our department from March 2013 to February 2015 were divided into routine training group (RT, =18) and comprehensive training group (CT, =28) according to their willingness. Two weeks after the wounds were healed, patients in group RT were treated with functional training of hands and self-made pressure gloves, while patients in group CT were treated with self-made hand flexing training band (consisting of nylon strap, flexing band, and velcro) on the basis of those in group RT. All patients were treated for 3 months. Before and after treatment, scar condition of affected hands was assessed with Vancouver Scar Scale (VSS). The range of motion of joints of affected hands was measured by Total Active Movement (TAM) Scale. The function of affected hands was evaluated by Carroll Upper Extremity Function Test. Data were processed with test, chi-square test, and Mann-Whitney test. (1) The score of VSS in patients of group RT was (10.0±1.9) points before treatment and (4.4±1.4) points after treatment, with the improved score of (5.6±1.0) points. The score of VSS in patients of group CT was (10.5±1.8) points before treatment and (4.6±1.4) points after treatment, with the improved score of (5.9±1.2) points. There was no statistically significant difference in the improved score of patients between the two groups (=0.834, >0.05). The score of VSS in patients of groups RT and CT after treatment was significantly lower than that before treatment (with values respectively 14.014 and 10.003, values below 0.01). (2) Before treatment, the ratios of excellent and good results according to TAM were 2/9 in patients of group RT and 3/14 in group CT, with no statistical differences between them ((2)=2.140, >0.05). After treatment, the ratio of excellent and good results according to TAM in patients of group CT (6/7) was higher than that in group RT (5/9, (2)=0.023, =0.038). The ratios of excellent and good results according to TAM in patients of groups RT and CT after treatment were significantly higher than those before treatment (with values respectively -2.023 and -4.780, values below 0.05). (3) The improved score of hand function in patients of group CT was (26±12) points, which was higher than (15±7) points in group RT (=3.278, =0.002). The score of hand function in patients of groups RT and CT after treatment was significantly higher than that before treatment (with values respectively 2.628 and 6.125, values below 0.05). There were no significant differences in grades of hand function of patients between the two groups before treatment (=-0.286, >0.05). After treatment, the grade of hand function in patients of group CT was higher than that in group RT(=-1.993, =0.046). The grades of hand function in patients of groups RT and CT after treatment were significantly higher than those before treatment (with values respectively -2.717 and -4.998, values below 0.01). For patients with scar contracture after burn injury of dorsal hand, early functional training combined with hand flexing training band can improve the range of motion of hand joints and functional recovery of hand, and the result was better than functional training alone.
观察功能训练联合自制手部屈伸训练带治疗手背烧伤后瘢痕挛缩的效果。选取2013年3月至2015年2月在我科住院的46例手背深Ⅱ度或Ⅲ度烧伤后瘢痕挛缩患者，根据其意愿分为常规训练组（RT组，n = 18）和综合训练组（CT组，n = 28）。伤口愈合2周后，RT组患者采用手部功能训练及自制压力手套治疗，CT组患者在RT组治疗基础上采用自制手部屈伸训练带（由尼龙带、屈伸带和魔术贴组成）治疗。所有患者均治疗3个月。治疗前后，采用温哥华瘢痕量表（VSS）评估患手瘢痕情况，采用总主动活动度（TAM）量表测量患手关节活动度，采用卡罗尔上肢功能测试评估患手功能。数据采用t检验、卡方检验和曼-惠特尼U检验进行处理。（1）RT组患者治疗前VSS评分为（10.0±1.9）分，治疗后为（4.4±1.4）分，改善分值为（5.6±1.0）分。CT组患者治疗前VSS评分为（10.5±1.8）分，治疗后为（4.6±1.4）分，改善分值为（5.9±1.2）分。两组患者改善分值比较差异无统计学意义（t = 0.834，P > 0.05）。RT组和CT组患者治疗后VSS评分均显著低于治疗前（t值分别为14.014和10.003，P值均< 0.01）。（2）治疗前，RT组患者TAM评定优、良率为2/9，CT组为3/14，两组比较差异无统计学意义（χ² = 2.140，P > 0.05）。治疗后，CT组患者TAM评定优、良率（6/7）高于RT组（5/9，χ² = 0.023，P = 0.038）。RT组和CT组患者治疗后TAM评定优、良率均显著高于治疗前（t值分别为 - 2.023和 - 4.780，P值均< 0.05）。（3）CT组患者手功能改善分值为（26±12）分，高于RT组的（15±7）分（t = 3.278，P = 0.002）。RT组和CT组患者治疗后手功能评分均显著高于治疗前（t值分别为2.628和6.125，P值均< 0.05）。两组患者治疗前手功能分级比较差异无统计学意义（Z = - 0.286，P > 0.05）。治疗后，CT组患者手功能分级高于RT组（Z = - 1.993，P = 0.046）。RT组和CT组患者治疗后手功能分级均显著高于治疗前（Z值分别为 - 2.717和 - 4.998，P值均< 0.01）。对于手背烧伤后瘢痕挛缩患者，早期功能训练联合手部屈伸训练带可改善手部关节活动度及手部功能恢复，效果优于单纯功能训练。
