【作者】 陈旗； 宋凡； 陈文红；

【Author】 Chen Qi, Song Fan, Chen Wen Hong et al.Dept.of Rehabilitation Medicine, The First Hospital Affiliated of Nanjing Medical University, Nanjing, 210029

【机构】 南京医科大学第一附属医院康复科；

【摘要】 目的 观察康复治疗对肝移植术后手功能障碍者恢复的帮助.方法 对一例行原位异体肝移植术后6天,出现双侧上肢麻胀感,不能进行伸腕及手部的抓握动作的患者进行康复治疗.具体为:双腋窝部用超短波对置无热量治疗,每次20分钟,共15次,同时进行上肢各关节进行无痛范围内的被动活动,对手部敏感区采用棉签、橡皮头触压以增加耐受性,每天5次,每次2分钟左右;2周后为出现抓握能力的手腕部设计拣小铁棒.握不同重量的易位罐作屈伸肘、腕练习的作业活动,并练习系钮扣、用勺子吃饭等日常功能性活动.分别在康复治疗前、治疗后2、5月复查握力、侧捏力、日常活动能力.结果 康复治疗前双手握力、侧捏力为0,Barthel指数评定45分,进食、穿衣等能力依赖别人.治疗后2月握力、侧捏力、日常活动能力有较明显进步,5月后双肘腕肌力5级,手功能基本恢复,握力左22公斤,右38公斤,侧捏力左6.7公斤,右12公斤.Barthel指数评定100分.恢复以右手为佳.结论 肝移植术后出现的双手功能障碍,与手术长时间放置上肢外展位,臂丛神经受牵拉有关.手功能损伤阻碍了患者生活自理能力,通过循序渐进的康复治疗患者完全可以恢复双手的功能,达到生活的自理.更多还原

【Abstract】 Objective To observe the treatment outcome of hand impairment patient after ortho-topic liver transplanted. Method lease was received rehabilitation training of hand impairment patient after orthotopic liver transplanted. Concreted for ultra- short wave contrapostin at axilla 20 minutes everyday for lasting 2 weeks, maintained passive range of motion of arms; reduced tenderness at foramen and hand with cotton bud and rubber 10minutes everyday after 2 weeks. Activity of daily living was used in the design of increase hand and wrist grasping. Gripping power,pnch strengt and ADL index were adopted toevaluate rehabilitation training of hand impairment patient before and after treatment. Result Hand function and ability of ADL of hand impairment patient were obviously improved after 5 months rehabilitation training. Conclusion Rehabilitation training of hand imparirment patient after orthotopic liver transplantation was maybe correlated with brachial plexus dragged during operation. It reduced ability of ADL. Rehabilitation training might improve hand function benificially.更多还原