物理治療介入對於下肢踝關節全層植皮手術燒燙傷患者的下肢功能與疤痕組織之影響：個案報告

Effects of Physical Therapy in Adults Following Lower Extremity Thermal Burn Injury With Autologous Full-Thickness Skin Graft: A Case Report

李純兒(Chun-Erh Lee) ； 吳佩璇(Katie Pei-Hsuan Wu)

《物理治療》 46卷4期 (2021/12) Pp. 263-271

https://doi.org/10.6215/FJPT.202112_46(4).0004

摘要

背景與目的：物理治療對於下肢踝關節燒燙傷（burn）全層植皮手術（full-thickness skin graft）後之介入，包含軟組織沾黏處理、關節活動度的增加及動作與平衡控制訓練。本篇想探討利用踝關節平衡控制訓練於下肢全層植皮手術患者的功能性表現與疤痕之影響。方法：個案為一名33歲四肢及臉部45%總體表面積（total body surface area）二到三度燒燙傷的男性患者，於傷後一年半因右側踝關節背側疤痕反覆感染出現傷口且疤痕肥厚，決定接受右側腳背全層植皮手術。術後使用紐若可平衡功能檢查儀（Smart Balance Master®;NeuroCom® International, Inc., Clackamas, OR, USA）的右側腳踝模式下去做踝關節策略之平衡訓練，為期6週且每週1次的20分鐘治療。其成果評估包含：踝關節主被動角度之測量、Balance Error Scoring System平衡評估、功能性伸取測試、臺灣中文版下肢功能評量表與超音波疤痕厚度偵測。結果：個案於右側踝關節主被動關節角度、站姿平衡能力、下肢功能評量表皆有進步；在超音波疤痕厚度偵測上其植皮手術的疤痕與所植上的自體皮膚皆有變薄。結論：使用踝關節平衡控制訓練於下肢全層植皮手術患者在下肢功能性表現上是有進步的，與全層植皮手術之疤痕變薄的相關性可再研究。

關鍵字

燒燙傷 ； 物理治療 ； 下肢功能 ； 全層植皮手術 ； 疤痕組織

並列摘要

Background and Purpose: An autologous full‐thickness skin graft is a common treatment for lower extremity thermal burn injuries to improve the appearance and function of the skin. Physical therapy prescriptions usually include soft tissue (scar adhesion) release, range of motion (ROM) exercises, stretching, motor-control training, and balance training. The purpose of this study was to evaluate the effect of ankle-balance training on functional performance and scar tissue in adults following lower extremity thermal burn injuries and autologous full‐thickness skin grafts. Methods: The subject was a 33-year-old male who had survived 2^(nd)- to 3^(rd)-degree thermal burn injuries to four limbs and the face area, a total body surface area of 45%. Because of recurrent infections and a persistent hypertrophic scar over the right dorsal side of the ankle, an autologous full-thickness skin graft was performed 18 months post-onset. After surgery, the thickness of the scar was significantly reduced, but post-skin-graft-associated soft tissue edema still affected skin elasticity and flexibility. In addition, ROM limitations of the ankle joint, decreased muscle strength, and an insufficient ability to carry out functional movements continued to limit the subject's quality of life. Hence, the patient received regular physical therapy after surgery comprising 6 weekly (20 minutes/session) ankle-balance training sessions, which began the 12^(th) week after surgery. The ankle-balance training was performed using the Smart Balance Master® (NeuroCom® International, Inc., Clackamas, OR, USA). The following protocol was used: (1) weight-shifting training mode and (2) closed-chain training-right-ankle mode. The aim of these training modes was to strengthen the ankle strategy for maintaining balance. Results: Multiple improvements were observed, including both anterior and posterior ROMs in the right ankle, standing balance, and an improved score on the lower extremity functional scale. In addition, ultrasound imaging indicated a notable decrease in the thickness of the scar tissue resulting from autologous full-thickness skin graft surgery and the skin graft after 6 weeks of ankle-balance training. Conclusion: Following lower extremity thermal burn injuries and autologous full‐thickness skin grafts in adults, ankle-balance training positively affected lower extremity function. Future studies should investigate the relationship between the improvement of lower extremity function and decreased scar-tissue thickness.

並列關鍵字

Burn ； Physical therapy ； Lower extremity function ； Full-thickness skin graft ； Scar