摘要
目的探讨行为观察疗法结合常规康复对臂丛神经损伤术后肩肘功能恢复的影响。方法将我科自2020年至2022年治疗的40例臂丛神经根性损伤术后患者随机分为治疗组20例和对照组20例。两组均接受神经功能重建术及常规康复治疗。治疗组在手外科康复室额外接受行为观察疗法治疗,一次30 min,一日两次。康复疗程后接受肩肘功能评定。结果经过9个月的康复治疗后,治疗组肩关节外展(28.3±10.3)°,Gilbert肩功能等级平均改善1.15,对照组肩外展(21.4±8.1)°(P=0.02),Gilbert等级改善0.95(P=0.04)。在屈肘功能恢复中,治疗组中3例患者屈肘达到全范围幅度(去除重力),9例患者达到>1/2关节活动度,5例患者<1/2关节活动度,3例患者肌肉没有收缩;对照组中分别是0、4例、8例和8例(P=0.048),两组屈肘肌力恢复差异有统计学意义(P=0.01)。从创伤-首次康复时间间隔≤6个月的两组患者中,肩外展改善分别为(35.25±9.44)°和(26.89±5.32)°,明显优于创伤-首次康复时间间隔>6个月以上患者(23.67±7.91)°和(16.91±7.15)°(P=0.011,P=0.004),两组中6个月之内介入康复的患者,其屈肘肌力恢复佳(P=0.013,P=0.015)。结论行为观察疗法结合常规康复治疗能显著改善肩、肘功能,且越早介入康复(创伤-首次康复时间间隔≤6个月)的患者功能恢复改善明显。
Objective To explore the effect of action observation therapy(AOT)combined with routine rehabilitation on the recovery of shoulder and elbow function after brachial plexus avulsion injury(BPAI).Methods A total of 40 postoperative patients with BPAI treated in our department from 2020 to 2022 were randomly divided into a treatment group of 20 cases and a control group of 20 cases.Both groups received nerve function reconstruction surgery and routine rehabilitation treatment.The treatment group received additional AOT in the hand surgery rehabilitation room,30 minutes per session and twice a day.After the rehabilitation course,the shoulder and elbow function were evaluated.Results After 9 months of rehabilitation treatment,the treatment group showed shoulder joint abduction(28.3±10.3)°,with an average improvement of 1.15 degrees in Gilbert shoulder function level.The control group showed shoulder abduction(21.4±8.1)°(P=0.02),with an improvement of 0.95 degrees in Gilbert function level(P=0.04).In the recovery of elbow flexion function,3 patients in the treatment group achieved full range of elbow flexion(excluding gravity),9 patients achieved more than 1/2 joint range of motion,5 patients achieved less than 1/2 joint range of motion,and 3 patients had no muscle contraction.In the control group,there were 0,4,8,and 8 cases respectively(P=0.048),and there was a statistically significant difference in the recovery of elbow flexion muscle strength between the two groups(P=0.01).Among the two groups of patients with a time interval of less than or equal to 6 months between trauma and first rehabilitation,the improvement in shoulder abduction was(35.25±9.44)°and(26.89±5.32)°,respectively,which were significantly better than those with a time interval of more than 6 months between trauma and first rehabilitation(23.67±7.91)°and(16.91±7.15)°(P=0.011,P=0.004).The patients with intervention rehabilitation within 6 months in both groups had better recovery in elbow flexion muscle strength(P=0.013,P=0.015).Conclusi
作者
徐晓君
周俊明
劳杰
Xu Xiaojun;Zhou Junming;Lao Jie(Department of Hand Surgery,Huashan Hospital,Fudan University,Shanghai 200040,China;NHC Key Laboratory of Hand Reconstruction(Fudan University),Shanghai 200032,China;Shanghai Key Laboratory of Peripheral Nerve and Microsurgery,Shanghai 200032,China;Institute of Hand Surgery,Shanghai 200040,China;Institute of Hand Surgery,Fudan University,Shanghai 200040,China)
出处
《中华手外科杂志》
CSCD
北大核心
2023年第6期527-531,共5页
Chinese Journal of Hand Surgery
基金
上海市重点临床专科项目(shslczdzk05601)
上海市周围神经显微外科重点实验室(20DZ2270200)。
关键词
臂丛
康复
行动观察疗法
镜像神经元
大脑重塑
Brachial plexus
Rehabilitation
Action observation therapy
Mirror neuron
Brain remodeling