手部熱壓傷之病患於早期復健介入之過程以一接受腹部皮瓣移植個案為例

A Case Study of Abdominal Pedicle Skin Flap Repairing and Early Intervention to the Patient who Suffered from Severe Hot Crush Injury in Hand

王柏堯(Po-Yao Wang) ； 邱然偉(Jan-Wei Chiu) ； 許嫚芳(Man-Fang Hsu) ； 劉若蘭(Ruo-Lan Liu)

《台灣復健醫學雜誌》 44卷3期 (2016/09) Pp. 161-168

https://doi.org/10.6315/2016.44(3)05

摘要

根據勞動部的調查，台灣的職業傷害的型態以上肢遭機器夾捲傷為大宗。為了使上肢獲得良好的修復與預後，常使用皮瓣移植方式重建，但此方法需要將肢體制動，所以易使個案因長期制動而引發關節僵硬、水腫等併發問題，影響傷手之復原。我們提出一個臨床個案，經由職能治療師透過術後早期的介入，在骨釘制動期對未制動之手指關節進行被動關節運動、皮膚疤痕介入。移除骨釘後，漸進式建立關節活動度、減少水腫現象。隨著關節角度的增加，開始強化肌肉耐力與靈巧度，最終導入日常功能訓練，個案於三個月後達成治療目標，結案復工。透過此個案我們整理出早期復健治療介入手部壓碎傷的面向，包括改善關節僵硬、水腫、良好擺位、肌力與日常功能訓練，透過漸進式的介入，隨著個案能力而調整目標，使個案的傷手功能得到最大的恢復。

關鍵字

手部熱壓碎傷(hand hot crush injury) ； 早期介入(early intervention) ； 關節僵硬(joint stiffness) ； 腹部皮瓣移植(pedicled groin flap)

並列摘要

Machine crush injury is the most common occupational injury in Taiwan. Machines operated at high pressures and temperatures can cause severe injury to the hands. To improve functional recovery of the hands, pedicled groin flap transfer is recommended. This reconstructive option is useful and versatile for covering hand wounds. The transfer yields predictable results with a procedure that is substantially less difficult and takes less time compared with free-tissue transfer; the disadvantage is that the extremity must be immobilized. Pedicled groin flap transfer can cause some complications, such as joint stiffness and edema, which can be prevented through early intervention occupational therapy. We examined a patient with a severe hot crush injury to the left hand and designed an early intervention program after she underwent the flap transfer and K-wire fixation. To prevent adhesions and joint stiffness, we executed passive range of motion（ROM）exercises to the fingers, which were immobilized at the first stage. After removing the K-wires, we began increasing the active ROM of the fingers and reducing the edema through massage. The patient showed significant improvements in the ROM of the metacarpophalangeal joints. Subsequently, we trained the muscle power and dexterity of the hand. Finally, the patient returned to work after aggressive treatment for 3 months. This case report revealed that providing early intervention for patients who have undergone a pedicled groin flap transfer can significantly improve（1）joint stiffness,（2）edema,（3）muscle power, and（4）ability to perform regular activities of daily living. Thus, we conclude that providing early intervention occupational therapy to patients with severe hand injury is critical for achieving optimal functional outcomes.

並列關鍵字

hand hot crush injury ； early intervention ； joint stiffness ； pedicled groin flap

參考文獻

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