应用肌间沟臂丛置管镇痛辅助肌腱粘连松解术后功能锻炼临床研究.docVIP

应用肌间沟臂丛置管镇痛辅助肌腱粘连松解术后功能锻炼临床研究 　　[摘要] 目的 探讨应用肌间沟臂丛置管镇痛辅助肌腱粘连松解术后功能锻炼的效果。 方法 选取我院于2012年1月～2013年12月间因屈指肌腱外伤修复术后发生肌腱粘连、需行肌腱粘连松解术的住院患者40例68指，随机分成A、B两组。A组为斜角肌间沟臂丛置管镇痛组，B组为常规治疗组。比较两组指关节总主动活动度、疼痛程度。 结果 术后1 d～1周A组给药前、给药后与B组的患指关节TAM有明显差异，且A组给药后TAM优良率明显增大。给药前、给药后、B组的NRS评分有明显差异，并且A组给药后患者疼痛明显改善（P0.05）。 结论 应用肌间沟臂丛置管镇痛后可明显减轻功能锻炼效果时的疼痛感，促进患者手部功能的恢复，减少肌腱再粘连的发生率。 　　[关键词] 肌腱粘连；肌间沟；臂丛置管；肌腱粘连松解术；功能锻炼 　　[中图分类号] R614 [文献标识码] B [文章编号] 1673-9701（2015）35-0032-03 　　[Abstract] Objective To investigate the application effect of interscalene brachial catheter plus functional exercise after tendon adhesion lysis. Methods A total of 40 patients with 68 fingers who hospitalized due to postoperative tendon adhesions of flexor tendon injury repair and the need of tendon adhesion lysis from January 2012 to December 2013 were chosen， and were randomly divided into group A and group B. Group A received scalene brachial plexus catheter analgesia， and group B received the conventional therapy. Knuckle total active activity and pain degree of the two groups were compared. Results There were significant differences in comparing knuckles TAM of group A before administration， group A after administration and group B after operation for 1 d to 1 week， and TAM good rate of group A after administration increased significantly. There were significant differences in comparing NRS scores of group A before administration， group A after administration and group B， and pain of patients in group A after administration significantly improved（P0.05）. Conclusion Application of brachial plexus catheter analgesia can significantly reduce the pain of functional exercise， promote recovery of hand function in patients and reduce the incidence of tendon re-adhesions. 　　[Key words] Tendon adhesions； Interscalene； Brachial plexus catheter； Tendon adhesion lysis； Functional exercise 　　肌腱粘连是肌腱损伤修复术后常见的并发症，肌腱粘连一旦发生会影响肌腱的滑动、导致肌腱修复手术的失败及影响肢体运动功能的恢复[1，2]。迄今为止，防止肌腱粘连最有效的措施还是肌腱损伤修复术后早期积极有效的功能锻炼。由于肌腱粘连松解术后功能锻炼时的剧烈疼痛会影响锻炼效果，因此，我们对在肌