| Background and purpose:Burns has been a hot topic, the annual global incidence is about 200/10 million to 400 / 100,000 [1]. It is a high incidence of common species, but is a serious injury to individuals, families, social disease.However, the early burn wound healing, does not mean the end of the clinical treatment of post-traumatic wound healing scar appeared hyperplasia, contracture and other issues, seriously affecting the patient's interpersonal social, work, self-care ability and psychological impact.Therefore, burn treatment, it must not be limited to the closure of burn patients' lives and treatment of wounds, but rather to maximize recovery of appearance and functionality, reduce the impact on the patient due to scar contracture caused by the physiological function. How to treat scarring after wound closure, so that clinicians also a difficult task.The research of scar, including his pathogenesis and prevention of the problem, so far, still haunt us [8]. It is an important issue links throughout the life sciences sector is very intricate. Scar isn't only affects the appearance, its strong anti-poor nature Yijiao normal skin tissue, in function, often due to shrinkage or pull resulting in dysfunction. For centuries, the scar has been plagued us, difficult to cure, and easy to relapse.Moderate scarring is a physiological and defensive performance, and hyperplasia belong to pathological changes [15]. Especially in the joints of the scar tissue that once formed the joints stretch, restricting joint activities will lead to decreased patient self-care ability or the ability of labor or even disappear, so, while improving mortality in burned patients, but also to pay attention to burn impact on patients' ability later in life and labor rehabilitation.Hand is an important tool for human survival, it plays an important role in human labor and life. Hand for the exposed parts, in the face of flame, human hands defense action is to extinguish the flames with his hands or concealed, and therefore more opportunities for injury. Although the surface area of two hands accounted for 5% total body surface area is not life threatening, but the healing process has easily lead to deformity. Some patients with burn scars, while not deep, but secondary diseases are very serious. Especially children, in the process of growth in the growth rate is slower than normal scar tissue around more easily lead to stretch, so that the hand function is impaired or lost.In recent years, rehabilitation medicine have made great progress, the concept of hand burns after early intervention in rehabilitation clinic also reached a consensus: a simple surgery can only solve the problem deformity, but can not solve the late scar contracture. Therefore, treatment of burn scar contractures early intervention must be comprehensive rehabilitation therapy.Rehabilitation apparatus or method of compensation by compensatory deformity correction to compensate for functional defects and prevent further degradation of the function, the patient is able to maximize self-care, return to society. Rehabilitation Equipment is an important means of rehabilitation. For scar contracture treatment, orthopedic brace is a good choice, it has the stability and support, fixation and correction, protection and load-free, and help move the compensatory function.A wide range of rehabilitation alone a cure is difficult to achieve the desired effect, so our department for many years experience in the treatment of hand burns proposed based on a combination of comprehensive rehabilitation after treatment method, that early postoperative intervention, the difference for the individual patient customized professional pressure sleeve and orthopedic appliances, and routine use of pressure sleeve and not the traditional treatment of orthopedic brace as a control to compare observed differences in efficacy of two programs.Rehabilitation assessment required response can indeed hand function evaluation [25]: finger joint total activity(Total Angle of Motion, TAM), ADL(Activities of Daily Living, ADL) and Jebsen hand function test.The present study is to investigate the clinical value of comprehensive rehabilitation therapy after correction of deformity after burn in hands of children, strive to find a more comprehensive rehabilitation program to provide a scientific basis for the treatment of hand deformities. Methods:May 2013- May 2015, according to uniform standards enrolled 60 patients were randomly divided into rehabilitation to strengthen the group and conventional treatment group, 30 patients in each. All patients received conventional autologous skin grafting and wound healing time in 20 to 30 days. Postoperative rehabilitation: Rehabilitation strengthen group was guiding hand function after surgery, exercise, carried out active and passive finger activities under the guidance of the physician, the joint use of pressure therapy and orthopedic brace comprehensive treatment. Traditional treatment group exercise guiding hand function after surgery, actively passive finger activities under the guidance of the physician. Two groups of patients were followed up for 3 months after surgery. Respectively, before rehabilitation and after 1 month, 3 months, measuring rehabilitation assessment index finger joints total activity(Total Angle of Motion, TAM), ADL(Activities of Daily Living, ADL) and Jebsen Hand Function Test. Results:Through the clinical trials for rehabilitation to strengthen the patients in the treatment group and the traditional group hand scar contracture of comparison,rehabilitation to strengthen the group in the scar,joint activity measurement, hand function and ability of daily life convenient are superior to the conventional treatment group: 2 groups of patients with scar improvement score differences are significant(t=1.452, P = 0.045); degree of joint activity of patients in two groups were excellent than differences significantly(t=8.507, P = 0.004); two groups of children with hand function test improve time difference(t=2.618, P = 0.012) significantly. The 2 groups of children with daily life activity ability to improve scores were significantly different(t=2.246, P=0.029). Conclusion:Through this experiment,on 60 cases of burn deformity patients of surgery and rehabilitation, through rehabilitation evaluation research obtained the following conclusions: burned hand scar contracture patients after autologous skin grafting. After comprehensive rehabilitation treatment effect is obviously superior to that of pure refers to the movement guide treatment. |
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