Serial Kinematic and Functional Assessments for Hand Motion Impairment: A Case Report with Hand Rehabilitation for a Comminuted Proximal Phalangeal Fracture

手部動作缺損之系列性運動學及功能性評估：以粉碎性近位指骨骨折個案接受手部復健介入為例

徐秀雲(Hsiu-Yun Hsu) ； 蘇芳慶(Fong-Chin Su) ； 邱浩遠(Haw-Yen Chiu) ； 林聖哲(Sheng-Che Lin) ； 郭立杰(Li-Chieh Kuo)

《職能治療學會雜誌》 31卷2期 (2013/12) Pp. 226-244

https://doi.org/10.6594/JTOTA.2013.31(2).06

摘要

運用運動學分析方法呈現關節動作表現較傳統之靜態角度量測更可客觀地提供空間及時間參數的表現，從臨床觀點而言，用系列性之運動學評估法可視為是一可信之量化治療成效之工具。然，這方法雖已早被提出，但卻顯少有文獻及臨床實務之報告呈現。本篇研究即以一粉碎性近端指骨骨折個案接受動態牽引副木及手部復健介入為例，欲凸顯使用系列性運動學及功能性評估在手部動作缺損上肢評估應用，透過電磁場動作分析系統及手部力量量測工具在系列性的追蹤評估中得知，個案之受傷手指指尖最大動作空間及動態關節活動度表現在介入後有明顯改善，另在關節動作的平滑度上，在系列性之追蹤評估中亦有所改善，個案之手部握力及指捏力亦隨復原之進展而有所進步。故本篇個案報告顯示此一系列性運動學及功能性評估可協助臨床人員透過即時或事後的檢查中，由所提供之動態時序及空間參數了解動作缺損之所在，除可提供診斷有利之依據外亦可對治療活動訂定之試且與否有更客觀之了解。

關鍵字

動作分析 ； 運動學 ； 動態牽引副木 ； 指骨骨折

並列摘要

Kinematical representation of joint motion can objectively provide spatial and temporal assessment rather than static indication using conventional goniometric measurements. From clinical perspectives, serial kinematic assessments are reliable methods of quantifying treatment outcomes. Although this technique has already been adopted over a span of years, limited literatures and actual clinical practices regarding this conception can be found. In this study, serial functional evaluations based on kinematic analysis in this study were performed as an example to confirm the effectiveness of dynamic traction splint and hand rehabilitation for a comminuted phalangeal fracture. We reported a case with comminuted spiral proximal phalangeal fracture of the right middle finger, which was treated using a dynamic traction splint with an out-trigger and an elastic band to pull the K-wire for periosteotaxis based on Schenck's method in order to avoid bony shortening and instability. A designed rehabilitation protocol was applied to this case. Follow-up motor function assessments were measured using an electromagnetic tracking system and strength measurement tools. Serial assessments of maximal fingertip workspace and joint range of motion of the injured finger were improved after intervention. Angular kinematics of the finger showed evidence of joint motion smoothness. The sequential movement performance was also improved. Follow-up assessments of both grasp and pinch power showed satisfactory improvement. This method allows clinicians to determine impairments of injured sites or movement deficiencies using dynamically temporal and spatial kinematics, whether in real-time or off-line movement examinations. This work establishes a consulting room measurement system conveniently providing clinicians to objectively assess patients' conditions for each visit.

並列關鍵字

Motion analysis ； Kinematics ； Dynamic traction splint ； Phalangeal fracture