Wollstein Ronit, Harel Hani, Lavi Idit, Allon Raviv, Michael Dafna
Department of Orthopedic Surgery, New York University, School of Medicine, Huntington Station, New York.
Carmel Lady Davis Medical Center Occupational Therapy, Haifa, Israel.
J Wrist Surg. 2019 Feb;8(1):2-9. doi: 10.1055/s-0038-1672151. Epub 2018 Sep 27.
Sensorimotor and specifically proprioception sense has been used in rehabilitation to treat neurological and joint injuries. These feedback loops are not well understood or implemented in wrist treatment. We observed a temporary sensorimotor loss, following distal radius fractures (DRF) that should be addressed postsurgery. The purpose of this prospective therapeutic study was to compare the outcomes of patients following surgery for DRF treated using a sensorimotor treatment protocol with those patients treated according to the postoperative standard of care. Patients following surgery for DRF sent for hand therapy were eligible for the study. Both the evaluation and treatment protocols included a comprehensive sensorimotor panel. Patients were randomized into standard and standard plus sensorimotor postoperative therapy and were evaluated a few days following surgery, at 6 weeks, and 3 months postsurgery. Sixty patients following surgery were randomized into the two treatment regimens. The initial evaluation was similar for both groups and both demonstrated significant sensorimotor deficits, following surgery for DRF. There was documented sensorimotor and functional improvement in both groups with treatment. The clinical results were better in the group treated with the sensorimotor-proprioception protocol mostly in the wrist; however, not all of the differences were significant. Patients after surgery for DRF demonstrate significant sensorimotor deficits which may improve faster when utilizing a comprehensive sensorimotor treatment protocol. However, we did not demonstrate efficacy of the protocol in treating proprioceptive deficits. Further study should include refinement of functional outcome evaluation, studying of the treatment protocol, and establishment of sensorimotor therapeutic guidelines for other conditions. This is a level II, therapeutic study.
感觉运动，特别是本体感觉，已被用于康复治疗神经和关节损伤。这些反馈回路在手腕治疗中尚未得到充分理解或应用。我们观察到桡骨远端骨折（DRF）后会出现暂时的感觉运动丧失，这在术后应予以关注。
本前瞻性治疗研究的目的是比较采用感觉运动治疗方案治疗DRF的患者与按照术后标准护理治疗的患者的治疗效果。
因DRF接受手术且被送去接受手部治疗的患者符合本研究的条件。评估和治疗方案均包括全面的感觉运动评估。患者被随机分为标准治疗组和标准加感觉运动术后治疗组，并在术后几天、6周和3个月进行评估。
60例接受手术的患者被随机分为两种治疗方案。两组的初始评估相似，且在DRF手术后均表现出明显的感觉运动缺陷。两组在治疗后均有感觉运动和功能改善的记录。采用感觉运动-本体感觉方案治疗的组在手腕方面的临床结果大多更好；然而，并非所有差异都具有统计学意义。
DRF手术后的患者表现出明显的感觉运动缺陷，采用全面的感觉运动治疗方案时可能改善得更快。然而，我们并未证明该方案在治疗本体感觉缺陷方面的疗效。进一步的研究应包括完善功能结局评估、研究治疗方案以及为其他病症制定感觉运动治疗指南。这是一项II级治疗研究。
