综合康复在汶川地震截肢伤员功能障碍的临床疗效分析

【】目的观察综合康复治疗对汶川地震截肢伤员功能障碍的临床疗效。方法对5?12汶川大地震22例挤压伤截肢患者的24条截肢残端实施护理、摆放良肢位、运动治疗、残端塑形、紫外线疗法、红外线疗法、石蜡疗法、音频电疗法、经皮电刺激神经疗法、关节松动、按摩和拍打、超短波治疗、作业疗法和心理治疗等综合康复治疗，直至截肢伤员出院为止。视觉模拟评分法量表评定幻肢痛疼痛强度、测定膝关节和髋关节活动范围、Barthel指数评定日常活动。结果治疗前幻肢痛疼痛强度为2.95±1.33，治疗后为0.50±0.96；治疗前肘关节活动范围为（90.0±28.3）?，治疗后为（135.0±7.1）?；治疗前肩关节屈伸活动范围为（68.8±27.8）?，治疗后为（137.5±9.6）?；治疗前肩关节收展活动范围为（53.8±7.5）?，治疗后为（96.3±4.8）?；治疗前膝关节活动范围为（91.0±23.0）?，治疗后为（123.0±6.7）?；治疗前髋关节屈伸活动范围为（86.9±25.9）?，治疗后为（132.3±13.8）?；治疗前髋关节收展活动范围为（46.9±10.9）?，治疗后为（64.6±8.7）?；治疗前Barthel指数为57.05±18.69，治疗后为78.18±13.85，康复治疗前后均有统计学意义（P<0.05）。结论地震后截肢不良残肢发生率高，综合康复治疗能促进截肢残端伤口愈合和消除残肢疼痛，可明显改善残肢条件，有利于地震截肢患者功能恢复和日常生活能力的提高，为后期的假肢安装及步态训练创造了条件。？【Abstract】ObjectiveToobservetheefficiencyofcomprehensiverehabilitationtherapyonamputationpatientsafterWenchuanearthquake.MethodsTwenty-twoamputationpatientsafterWenchuanearthquakewith24stumpsweretreatedwithpostoperativewoundcare,maintainingthecorrectpositionofthelimbs,exercisetherapy,stumpshaping,ultraviolettherapy,infraredtherapy,paraffintherapy,audioelectrotherapy,transcutaneouselectricalnervestimulationtherapy,jointmobilization,massage,beat,ultrashortwavetherapy,occupationaltherapyandpsychotherapyandsoonuntildischarged.TheresultsweremeasuredfromthefollowingaspectspainintensityusingVAS,rangementofkneejointandhipjoint,BarthelindexofADLbeforeandafterrehabilitation.ResultsPainintensityofphantomlimbpainwere(2.94±1.53)beforerehabilitation,and(0.44±1.03)after;themovementrangeofelbowwas(90.0±28.3)?beforeand(135.0±7.1)?after;themovementrangeofshoulderflexionandextensionwas(68.8±27.8)?beforeand(137.5±9.6)?after;themovementrangeofshoulderabductionandadductionwas(53.8±7.5)?beforeand(96.3±4.8)?afterrehabilitation;themovementrangeofkneewas(91.0±23.0)?beforeand(123.0±6.7)?afterrahabiliation;themovementrangeofhipflexionandextensionwas(86.9±25.9)?beforeand(132.3±13.8)?after;themovementrangeofhipabductionandadductionwas(46.9±10.9)?beforeand(64.6±8.7)?after;thescoreofBarthelindexwas57.05±18.69beforeand78.18±13.85after.Thedifferencebetweenbeforeandafterrehabilitationwerestatisticallysignificant(P<0.05).ConclusionTheincidenceofadverseamputationstumpsaftertheearthquakewashigh.Integrativerehabilitationhasanpositiveeffectonpromotingwoundhealing,byeliminatingstumppainandrecoveringlowerlimbfunction,improvingdailylivingfunctionandsocialability,andcreatingconditionsforinstallingprosthesislimbsandgaittraininginlaterperiod.