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中华老年骨科与康复电子杂志

中华老年骨科与康复电子杂志 ›› 2021, Vol. 07 ›› Issue (03) : 164 -169. doi: 10.3877/cma.j.issn.2096-0263.2021.03.007

康复医学

手法淋巴引流结合肌内效贴治疗中早期手碾压伤患者肿胀的临床研究
杨占宇1,†(), 王旼娴1, 龙青燕1, 黄犇1, 周学梅1, 郭艳萍1   
  1. 1. 215132　苏州瑞盛康复医院康复医学科
  • 收稿日期:2019-12-04 出版日期:2021-06-05
  • 通信作者: 杨占宇
  • 基金资助:
    苏州市相城区科技计划项目民生科技专项(No.201705)

A clinical study of treatments to edema by manual lymphatic drainage combined with kinesio taping on patients with hand crushing injury in early-middle phase

Zhanyu Yang1,†(), Minxian Wang1, Qingyan Long1, Ben Huang1, Xuemei Zhou1, Yanping Guo1   

  1. 1. Department of Rehabilitation, Suzhou Ruisheng rehabilitation hospital, Suzhou 215132, China
  • Received:2019-12-04 Published:2021-06-05
  • Corresponding author: Zhanyu Yang
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杨占宇, 王旼娴, 龙青燕, 黄犇, 周学梅, 郭艳萍. 手法淋巴引流结合肌内效贴治疗中早期手碾压伤患者肿胀的临床研究[J]. 中华老年骨科与康复电子杂志, 2021, 07(03): 164-169.

Zhanyu Yang, Minxian Wang, Qingyan Long, Ben Huang, Xuemei Zhou, Yanping Guo. A clinical study of treatments to edema by manual lymphatic drainage combined with kinesio taping on patients with hand crushing injury in early-middle phase[J]. Chinese Journal of Geriatric Orthopaedics and Rehabilitation(Electronic Edition), 2021, 07(03): 164-169.

目的

观察手法淋巴引流结合肌内效贴治疗中早期手掌碾压伤术后患者肿胀的疗效。

方法

前瞻性收集临床确诊为手掌部碾压伤病程1个月以上、肿胀较重的患者30例，按随机数字表法分成对照组（n=15）和试验组（n=15）。对照组给予常规手法治疗、肌肉力量、超声波、低频、蜡疗、作业训练、中药薰药等治疗。试验组执行对照组相同治疗方案基础上增加手法淋巴引流结合肌内效贴治疗。以上治疗每日1次，7 d一个疗程，连续治疗3个疗程。于治疗前和治疗后对两组患者的上肢综合功能（DASH评分）、手部灵活性（9孔木插板）、手部肿胀程度（手掌围度）进行评估。

结果

治疗后，两组患者治疗后DASH评分[（46±12、41±6）分]、9孔木插板时间[（39±5、32±4）秒]、手掌围度[（21.8±1.1、21.6±1.3）cm]与治疗前比较，差异均有统计学意义（P<0.05），治疗后试验组的DASH评分、手掌围度、9孔木插板时间均优于对照组，差异有统计学意义（P<0.05）。

结论

手掌部碾压伤患者在常规康复治疗基础上增加手法淋巴引流及肌内效贴治疗，可以改善患者手部肿胀程度，促进手功能恢复。

关键词: 手损伤, 肌内效贴, 手法淋巴引流
Objective

To investigate the efficacy of manual lymphatic drainage combined with kinesio taping in the treatment of edema on patients with hand crushing injury in early-middle phase.

Methods

All 30 patients with severe edema after hand crushing injury for over 1 month were randomly divided into control group (n=15) and experimental group (n=15). The control group received routine rehabilitation therapy, including manipulation, strength training, ultra-sound and low-frequency electronic pulse therapy, kerotherapy, occupational therapy and herbal fumigating. The experimental group received manual lymphatic drainage combined with kinesio taping on the basis of routine rehabilitation therapy. Both groups were treated once a day for 3 weeks. DASH scale, 9-hole peg test, palm girth measurement were used to assess upper extremity function, finger mobility and edema before and after treatment.

Results

Three weeks after treatments, the DASH scores (46±12, 41±6)points, the time required to insert nine-hole wooden board(39±5, 32±4)s and palm circumference (21.8±1.1, 21.6±1.3)cm were improved in these groups as compared with those before treatments,differences were statistically significant (P<0.05). As compared with control group, the DASH scores, the time required to insert nine-hole wooden board and palm circumference were also improved, differences were statistically significant (P<0.05).

Conclusion

On the basis of routine rehabilitation therapy, manual lymphatic drainage combined with kinesio taping can alleviate the edema and promote the recovery of hand function.

Key words: Hand injuries, Kinesio taping, Manual lymphatic drainage
表1 两组手碾压伤患者一般资料对比
组别 例数 性别（例，男/女） 年龄（岁，±s） 病程（天，±s） 掌骨骨折（例，有/无） Gustilo分型（例，Ⅰ/Ⅱ/ⅢA/ⅢB/ⅢC）
对照组 15 9/6 38±10 49±4 12/3 10/3/2/0/0
试验组 15 7/8 36±10 47±4 13/2 11/3/1/0/0
统计值   χ2=0.536 t=0.508 t=1.04 χ2=0.240 χ2=0.381
P值   0.715 0.616 0.307 1 0.827
图2 手背侧1至2条爪型贴，尾贴一直到手指远端
表2 两组手碾压伤患者治疗前后DASH评分比较（分，±s）
组别 例数 治疗前 治疗后 t值 P值
对照组 15 59±12 46±12 17.537 <0.01
试验组 15 60±8 41±6 12.730 <0.01
t值   -0.297 -3.454    
P值   0.769 0.020    
表3 两组手碾压伤患者治疗前后手掌围度比较（cm，±s）
组别 例数 治疗前 治疗后 t值 P值
对照组 15 22.4±1.3 21.8±1.1 7.253 <0.01
试验组 15 22.6±1.4 21.6±1.3 11.093 <0.01
t值   -0.282 -3.241    
P值   0.78 0.030    
表4 两组手碾压伤患者治疗前后9孔木插板时间比较（s，±s）
组别 例数 治疗前 治疗后 t值 P值
对照组 15 43±6 39±5 11.00 <0.01
试验组 15 41±6 32±4 13.012 <0.01
t值   0.916 -6.055    
P值   0.294 <0.01    
表5 两组手碾压伤患者治疗前后WHOQOL-BREF评分比较（分，±s）
组别 例数 生理 心理 社会关系 环境
治疗前 治疗后 治疗前 治疗后 治疗前 治疗后 治疗前 治疗后
对照组 15 4±14 53±14 58±14 60±13 70±9 70±10 57±10 61±8
试验组 15 48±10 65±11 55±10 69±7 69±9 70±9 59±10 60±7
t值   -0.414 -2.465 0.577 -2.59 0.251 -0.094 -0.586 0.702
P值   0.682 0.021 0.568 0.015 0.804 0.926 0.563 0.488
1
易传军，李忠哲，田光磊，等. 急诊手外伤的流行病学调查[J]. 中华手外科杂志，2011，27(3)：149-152.
2
侯瑞兴，巨积辉. 苏州地区手外伤住院患者的流行病学调查[J]. 实用手外科杂志，2011，25(3)：181-183，207.
3
刘飞，路潜，欧阳倩，等. 乳腺癌患者术后淋巴水肿与其相关症状的关系研究[J]. 中华护理杂志，2016，51(5)：518-522.
4
袁帅，丁喆如，吴宇黎，等. 膝关节镜下前交叉韧带重建术后冰敷对患者早期康复效果的影响[J]. 中华老年骨科与康复电子杂志，2019，5(4)：190-195.
5
郭家良，王海立，董维冲，等. 老年肱骨近端骨折的治疗与康复研究进展[J]. 中华老年骨科与康复电子杂志，2019，5(4)：233-237.
6
刘澍雨，朱伟民，刘雨微，等. 快速康复外科理念在老年髋部骨折中的术前应用[J]. 中华老年骨科与康复电子杂志，2021，7(1)：60-64.
7
蔡珍珍，毛宇星，姜嫚，等. 手法淋巴引流的临床运用研究进展[J]. 中国康复理论与实践，2017，23(12)：1411-1414.
8
Hörmann J, Vach W, Jakob M, et al. Kinesiotaping for postoperative oedema - what is the evidence? A systematic review [J]. BMC Sports Sci Med Rehabil, 2020, 2(12): 14.
9
Tornatore L, De Luca ML, Ciccarello M, et al. Effects of combining manual lymphatic drainage and Kinesiotaping on pain, edema, and range of motion in patients with total knee replacement: a randomized clinical trial [J]. Int J Rehabil Res, 2020, 43(3): 240-246.
10
Wee SK, Hughes AM, Warner MB, et al. Effect of trunk support on upper extremity function in People with chronic stroke and People who are healthy [J]. Phys Ther, 2015, 95(8): 1163-1171.
11
恽晓平. 康复疗法评定学[M]. 第2版. 北京：华夏出版社，2005：551.
12
Gradalski T, Ochalek K, Kurpiewska J. Complex decongestive lym phatic therapy with or without vodder II manual lymph drainage in more severe chronic postmastectomy upper limb lymphedema: a randomized noninferiority prospective study [J]. J Pain Symptom Manage, 2015, 50(6): 750-757.
13
Freire DM, Costa GM, Pace DM, et al. Manual lymphatic drainage and active exercise effects on lymphatic function do not translate into morbidities in women who underwent breast cancer surgery [J]. Arch Phys Med Rehabil, 2017, 98(2): 256-263.
14
Roth C, Stitz H, Roth C, et al. Craniocervical manual lymphatic drainage and its impact on intracranial pressure - a pilot study [J]. Europ J Neurol, 2016, 23(9): 1441-1446.
15
Bazigou E, Makinen T. Flow control in our vessels: vascular valves make sure there is no way back [J]. Cell Mol Life Scis, 2013, 70(6): 1055-1066.

URL    
16
Dos Santos Crisóstomo RS, Costa DS, De Luz Belo Martins C, et al. Influence of manual lymphatic drainage on health-related quality of Life and symptoms of chronic venous insufficiency: a randomized controlled trial [J]. Arch Phys Med Rehabil, 2015, 96(2): 283-291.
17
De Vrieze T, Vos L, Gebruers N, et al. Protocol of a randomised controlled trial regarding the effectiveness of fluoroscopy-guided manual lymph drainage for the treatment of breast cancer-related lymphoedema (EFforT-BCRL trial) [J]. Eur J Obstet Gynecol Reprod Biol, 2018, 221: 177-188.
18
Ezzo J, Manheimer E, Mcneely ML, et al. Manual lymphatic drainage for lymphedema following breast cancer treatment [J]. Cochrane Database Syst Rev, 2015, 21(5): CD003475.
19
Pichonnaz C, Bassin JP, Lécureux E, et al. Effect of manual lymphatic drainage after total knee arthroplasty: a randomized controlled trial [J]. Arch Phys Med Rehabil, 2016, 97(5): 674-682.
20
Ebert JR, Joss B, Jardine B, et al. Randomized trial investigating the efficacy of manual lymphatic drainage to improve early outcome after total knee arthroplasty [J]. Arch Phys Med Rehabil, 2013, 94(11): 2103-2111.
21
李贞晶，孟宪忠，瞿昱，等. 早期应用淋巴引流结合持续被动活动对膝关节周围骨折术后康复的影响[J]. 中国康复，2019，34(5)：247-249.
22
张启富，陈耀智，龙耀斌. 徒手淋巴引流结合消肿治疗闭合性小腿骨折术前肢体肿胀的效果[J]. 广东医学，2016，37(7)：1034-1036.
23
Petrek JA, Pressman PI, Smith RA. Lymphedema: current issues in research and management [J]. CA Cancer J Clin, 2000, 50(5): 292-307; quiz 308-11.
24
Ochalek K, Gradalski T, Pansch H. Preventing early postoperative arm swelling and lymphedema manifestation by compression sleeves afer axillary lymph node interventions in breast cancer patients:A randomized controlled trial [J]. J Pain Symptom Manage, 2017, 54(3): 346.
25
Shao Y, Zhong DS. Manual lymphatic drainage for breast cancer-related lymphoedema [J]. Eur J Cancer Care (Engl), 2017, 26(5): 1-5.
26
Donec V, Kriščiūnas A. The effectiveness of Kinesio Taping® after total knee replacement in early postoperative rehabilitation period. A randomized controlled trial [J]. Eur J Phys Rehabil Med, 2014, 50(4): 363-371.
27
田笑笑，严程，张翔，等. 肌内效贴联合常规康复治疗对偏瘫患者早期手肿胀的疗效观察[J]. 中国康复，2017，32(5)：411-413.
28
刘生发，张锋. 肌内效贴结合淋巴引流手法治疗全膝关节置换后下肢肿胀[J]. 中国组织工程研究，2017，21(11)：1647-1651.
29
祁奇，王予彬，陈文华，等. 肌内效贴在运动损伤康复中的应用进展[J]. 中国康复医学杂志，2013，28(10)：971-974.
30
Cho HY, Kim EH, Kim J, et al. Kinesio taping improves pain, range of motion, and proprioception in older patients with knee osteoarthritis: a randomized controlled trial [J]. Am J Phys Med Rehabil, 2015, 94(3): 192-200.
31
Chang HY, Chou KY, Lin JJ, et al. Immediate effect of forearm Kinesio taping on maximal grip strength and force sense in healthy collegiate athletes [J]. Phys Ther Sport, 2010, 11(4): 122-127.

URL    
32
Chang HY, Wang CH, Chou KY, et al. Could forearm Kinesio Taping improve strength, force sense, and pain in baseball pitchers with medial epicondylitis? [J]. Clin J Sport Med, 2012, 22(4): 327-333.

URL    
33
Huang YC, Chang KH, Liou TH, et al. Effects of Kinesio taping for stroke patients with hemiplegic shoulder pain: A double-blind, randomized, placebo-controlled study [J]. J Rehabil Med, 2017, 49(3): 208-215.
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