目的 研究肌骨超声定位引导下冲击波治疗手掌腕部和前臂外伤术后继发手部肌腱粘连的效果.方法 手掌腕部和前臂外伤术后继发手部肌腱粘连患者80例,按随机数字表法分为治疗组和对照组,每组40例,两组患者均给予手掌腕部和前臂肌腱康复治疗,如蜡疗、关节松动术、作业治疗.对照组患者,根据关节活动度受限情况,徒手检查确定手掌腕部和前臂肌腱粘连部位,给予冲击波治疗;治疗组患者,先对手掌腕部和前臂肌骨超声检查,确定肌腱粘连部位,进行标记定位,再根据定位进行冲击波治疗.两组患者均康复治疗4周,治疗前后对两组患者进行肌骨超声评估手部肌腱粘连程度,肌腱总主动活动度(TAM)测定,VAS疼痛视觉模拟评分评定,上肢及手功能DASH问卷评分测定.结果 两组患者在治疗前手部肌腱粘连程度、肌腱TAM、疼痛VAS评分、上肢及手功能DASH评分比较差异无统计学意义(P＞0.05),具有可比性.治疗4周后两组患者手部肌腱粘连程度明显改善,肌腱TAM增加,疼痛VAS评分降低,上肢及手功能DASH评分升高,但是治疗组患者手部肌腱粘连程度改善更明显,肌腱TAM增加更多,疼痛VAS评分降低更明显,上肢及手功能DASH评分升高更多,两组比较,差异有统计学意义(P＜0.01).结论 肌骨超声定位引导下冲击波治疗结合常规康复治疗可以明显改善继发性手部肌腱粘连,恢复手部分功能.
Objective To investigate the efficacy of shockwave therapy for secondary hand tendon adhesions fol-lowing palm,wrist,and forearm injuries under musculoskeletal ultrasound-guided localization.Methods Eighty pa-tients with secondary hand tendon adhesions after palm,wrist,and forearm injuries were randomly divided into treatment group and control group,with 40 cases in each group.Both groups received conventional rehabilitation treatments for hand tendon adhesions,such as wax therapy,joint mobilization,and occupational therapy.Patients in the control group under-went shockwave therapy based on manual examination to determine the sites of tendon adhesions according to joint mobility limitations.Patients in the treatment group underwent musculoskeletal ultrasound examination to identify the sites of tendon adhesions,followed by marking and localization,before receiving shockwave therapy.Both groups underwent rehabilitation treatment for 4 weeks.Musculoskeletal ultrasound assessment,total active motion(TAM)of hand tendons,Visual Analog Scale(VAS)pain score,and Disabilities of the Arm,Shoulder and Hand(DASH)questionnaire scores were evaluated before and after treatment.Results There were no statistically significant differences in hand tendon adhesion degree,TAM,VAS pain score,and DASH scores between the two groups before treatment(P＞0.05),demonstrating compara-bility.After 4 weeks of treatment,both groups showed significant improvement in hand tendon adhesion degree,increased TAM,reduced VAS pain score,and improved DASH scores.However,the treatment group exhibited more significant im-provements in hand tendon adhesion degree,greater increase in TAM,more pronounced decrease in VAS pain score,and greater improvement in DASH scores compared to the control group,with statistically significant differences(P＜0.01).Conclusion Shockwave therapy guided by musculoskeletal ultrasound localization combined with conventional rehabilita-tion treatment can significantly improve secondary hand tendon adhesions and restore partial hand function.
张启富;周开斌;龙耀斌;陈在娟;陈耀智
广西医科大学第二附属医院康复医学科(广西南宁 530007)
临床医学
超声引导;冲击波;康复治疗;手肌腱粘连
ultrasound guidance;shock wave;rehabilitation treatment;tendon adhesion of hand
《广东医学》 2024 (003)
318-323 / 6
广西壮族自治区卫生健康委员会课题(Z20200456);广西壮族自治区医疗卫生重点学科(桂卫科教发[2022]4号)
10.13820/j.cnki.gdyx.20230202
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