[1]王德明,鲁青,张立新,等.带蒂皮瓣移植修复手术诱发冻结肩的预防和治疗研究[J].第三军医大学学报,2018,40(06):537-542.
 WANG Deming,LU Qing,ZHANG Lixin,et al.Prevention and treatment of frozen shoulder induced by abdominal pedicle flaps transplantation [J].J Third Mil Med Univ,2018,40(06):537-542.
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带蒂皮瓣移植修复手术诱发冻结肩的预防和治疗研究(/HTML )
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《第三军医大学学报》[ISSN:1000-5404/CN:51-1095/R]

卷:
40卷
期数:
2018年第06期
页码:
537-542
栏目:
临床医学
出版日期:
2018-03-30

文章信息/Info

Title:
Prevention and treatment of frozen shoulder induced by abdominal pedicle flaps transplantation
 
作者:
王德明鲁青张立新丁小珩葛蕤温宝磊张欣储艳
青岛,解放军第401医院:全军手外科中心,医务处
Author(s):
WANG Deming LU Qing ZHANG Lixin DING Xiaoheng GE Rui WEN Baolei ZHANG Xin CHU Yan

Center of Hand Surgery, Department of Medical Affairs, No. 401 Hospital of PLA, Qingdao, Shandong Province, 266071, China

关键词:
带蒂皮瓣冻结肩预防和治疗手法松解
Keywords:
pedicle flaps frozen shoulder prevention and treatment manipulation under anesthesia
分类号:
R181.32;R622.1;R684
文献标志码:
A
摘要:

目的    探讨手、腕部或前臂皮肤缺损进行腹部皮瓣(带蒂)修复术时诱发冻结肩的预防和治疗。方法    选择手、腕部或前臂腹部皮瓣断蒂术患者60例,分为研究组和对照组,每组30例。研究组患者采用臂丛神经阻滞(肌间沟入路)+硬腰联合麻醉,腹部皮瓣断蒂术时兼顾对肩关节进行被动手法松解治疗和术后主动肩关节功能锻炼。对照组患者采用局麻或臂丛神经阻滞(肌间沟入路)+硬腰联合麻醉进行腹部皮瓣断蒂术。术后两组患者均进行患者静脉自控镇痛。断蒂术后2周对两组患者肩关节疼痛、Constant肩关节功能评分及肩关节活动度进行临床评估。结果    术后2 周,研究组患者Constant肩关节功能评分高于对照组 (P<0.01),研究组患者肩关节疼痛及活动功能的改善情况显著优于对照组(P<0.05) ,研究组患者临床治愈率、显效率明显优于对照组 (P<0.05),研究组患者麻醉效果优于对照组。结论    利用术中臂丛阻滞(肌间沟入路)复合硬腰联合麻醉提供的无痛及肌松条件,行肩关节的手法松解并且于术后配合主动的肩关节功能锻炼,能够预防和治疗带蒂皮瓣修复术后继发冻结肩,促进手及肩关节功能全面恢复,减轻术后痛苦,提高患者的生活质量。

Abstract:

Objective    To discuss the prevention and treatment of frozen shoulder induced by abdominal pedicle flaps transplantation to repair the skin defect of the hand, wrist or forearm. Methods    Sixty patients admitted in our center undergoing elective abdominal pedicle flaps transplantation for skin defect were enrolled in this study. They were prospectively divided into the observation group and control group B, with 30 cases in each group. The patients in the observation group were treated with brachial plexus block (interscalene approach) and intraspinal anesthesia. When the pedicle of the abdominal flap was broken, the shoulder joint was treated with passive manipulation under anaesthesia and active shoulder joint function exercise after the operation. The patients in the control group were treated with local anesthesia or brachial plexus block (interscalene approach) and intraspinal anesthesia when the pedicle of the abdominal flap was broken. All patients in the 2 groups received patient-controlled intravenous analgesia (PCIA) postoperatively. In 2 weeks after surgery, the pains, range of motion (ROM) of shoulder joint and the score of Constant were evaluated to assess the function of the shoulder in both groups. Results    In 2 weeks after operation, the Constant score was significantly higher in the observation group than the control group (P<0.01). The former group had better pain relief and ROM of shoulder joint (P<0.05), higher cure rate and effective rate (P<0.05), and better anesthetic effect when compared with the latter group. Conclusion    When the pedicle of the abdominal flap is broken, we should give consideration to the prevention and treatment of frozen shoulder caused by operation, which can promote the full recovery of hand and shoulder joint function, relieve postoperative pain and improve the quality of life in the patients.
 

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[1]李起鸿,周仲安,区伯平,等.颈椎病与冻结肩——冻结肩发病机制的探讨与介绍一种新疗法[J].第三军医大学学报,1981,03(02):0.[doi:10.16016/j.1000-5404.1981.02.010 ]

更新日期/Last Update: 2018-03-23