Comprehensive Rehabilitation on Amputation Patients after Wenchuan Earthquake_West China Medical Journal

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1. Department of Rehabilitation, 2. Department of Orthopedics, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, P. R. China;

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Keywords：

汶川地震; 截肢; 綜合康復

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【摘要】目的 觀察綜合康復治療對汶川地震截肢傷員功能障礙的臨床療效。方法對5?12汶川大地震22例擠壓傷截肢患者的24條截肢殘端實施護理、擺放良肢位、運動治療、殘端塑形、紫外線療法、紅外線療法、石蠟療法、音頻電療法、經皮電刺激神經療法、關節松動、按摩和拍打、超短波治療、作業療法和心理治療等綜合康復治療，直至截肢傷員出院為止。視覺模擬評分法量表評定幻肢痛疼痛強度、測定膝關節和髖關節活動范圍、Barthel指數評定日常活動。結果治療前幻肢痛疼痛強度為2.95±1.33，治療后為0.50±0.96；治療前肘關節活動范圍為（90.0±28.3）o，治療后為（135.0±7.1）o；治療前肩關節屈伸活動范圍為（68.8±27.8）o，治療后為（137.5±9.6）o；治療前肩關節收展活動范圍為（53.8±7.5）o，治療后為（96.3±4.8）o；治療前膝關節活動范圍為（91.0±23.0）o，治療后為（123.0±6.7）o；治療前髖關節屈伸活動范圍為（86.9±25.9）o，治療后為（132.3±13.8）o；治療前髖關節收展活動范圍為（46.9±10.9）o，治療后為（64.6±8.7）o；治療前Barthel指數為57.05±18.69，治療后為78.18±13.85，康復治療前后均有統計學意義（P lt;0.05）。結論地震后截肢不良殘肢發生率高，綜合康復治療能促進截肢殘端傷口愈合和消除殘肢疼痛，可明顯改善殘肢條件，有利于地震截肢患者功能恢復和日常生活能力的提高，為后期的假肢安裝及步態訓練創造了條件。
【Abstract】 Objective To observe the efficiency of comprehensive rehabilitation therapy on amputation patients after Wenchuan earthquake. Methods Twenty-two amputation patients after Wenchuan earthquake with 24 stumps were treated with postoperative wound care, maintaining the correct position of the limbs, exercise therapy, stump shaping, ultraviolet therapy, infrared therapy, paraffin therapy, audio electrotherapy, transcutaneous electrical nerve stimulation therapy, joint mobilization, massage, beat, ultrashort wave therapy, occupational therapy and psychotherapy and so on until discharged. The results were measured from the following aspects: pain intensity using VAS, rangement of knee joint and hip joint, Barthel index of ADL before and after rehabilitation. Results Pain intensity of phantom limb pain were (2.94±1.53) before rehabilitation,and (0.44±1.03) after; the movement range of elbow was (90.0±28.3)o before and(135.0±7.1)o after; the movement range of shoulder flexion and extension was (68.8±27.8)o before and (137.5±9.6)o after; the movement range of shoulder abduction and adduction was (53.8±7.5)o before and (96.3±4.8)o after rehabilitation; the movement range of knee was (91.0±23.0)o before and (123.0±6.7)o after rahabiliation; the movement range of hip flexion and extension was (86.9±25.9)o before and (132.3±13.8)o after; the movement range of hip abduction and adduction was (46.9±10.9)o before and (64.6±8.7)o after; the score of Barthel index was 57.05±18.69 before and 78.18±13.85 after. The difference between before and after rehabilitation were statistically significant (P lt;0.05). Conclusion The incidence of adverse amputation stumps after the earthquake was high. Integrative rehabilitation has an positive effect on promoting wound healing, by eliminating stump pain and recovering lower limb function, improving daily living function and social ability, and creating conditions for installing prosthesis limbs and gait training in later period.

Citation： YUAN Julian,DUAN Xin,XIE Guosheng,HE Chengqi. Comprehensive Rehabilitation on Amputation Patients after Wenchuan Earthquake. West China Medical Journal, 2010, 25(9): 1632-1635. doi: Copy

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1. 肖軍章. 疼痛評估方法的優與劣[J]. 中國臨床醫藥研究雜志, 2007, 177(15): 39-40.
2. 胡必杰, 陶黎黎. 地震災害傷員的常見感染類型和預治對策[J], 中華醫院感染學雜志, 2008, 18(6): 3-5.
3. 張慶江. 地震災害緊急醫療救援的難點及對策探討[J], 武警醫學, 2006, 17(10): 788-789.
4. Halbert J, Crotty M, Camemn ID. Evidence for the optimal management of acute and chronic phantom pain: a systematic review[J]. Clin J Pain, 2002, 18(2): 84-92.
5. Mortimer CM, Steedman WM, McMillan IR, et al. Patient information on phantom limb pain: a focus group study of patient experiences, perceptions and opinions[J]. Health Educ Res, 2002, 17(3): 291-304.
6. Whyte AS, Niven CA. Psychological distress in amputees with phantom limb pain[J]. J Pain Symptom Manage, 2001, 22(5): 938-946.
7. Hill A. Phantom limb pain: a review of literature on attributes and potential mechanisms[J]. J Pain Symptom Manage, 1999, 17(2): 125-142.
8. 錢紅, 黃勇, 朱守政. 早期介入作業療法對急性腦卒中偏癱患者上肢運動功能及ADL能力的影響[J]. 中國康復醫學雜志, 2007, 22(4): 343-344.
9. 閆彥寧, 賈子善, 王麗春. 在綜合醫院實施作業治療初探[J]. 中國康復醫學雜志, 2006, 21(1): 77-78.

West China Medical Journal

Comprehensive Rehabilitation on Amputation Patients after Wenchuan Earthquake

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