基本生理科学及支架应用原理.doc

啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊僵硬手 - 基本生理科学及支架应用原理(Basic Physiological Science and Splinting Principles of Stiff Hand)黄曼华 (香港) 威尔斯亲王医院.啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊基本生理科学及支架应用原理啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊僵硬手 - 基本生理科学及支架应用原理(Basic Physiological Science and Splinting Principles of Stiff Hand)黄曼华 (香港) 威尔斯亲王医院Stiff hand is an unwanted but common consequence of a variety of complications after injuries. Loss of motion of the fingers and wrist is usually caused by prolonged retention of edematous fluid, scar formation, lengthy period of immobilization, and a combination of all. To minimize the severity of complications, efforts including edema control, early joint motion through active and passive mobilization programs and serial splinting are indispensable. The ultimate goal is to provide beneficial biological effect on adhesion formation around the healing tissues and their adjacent structures. The most common post-traumatic joint contractures are the metacarpophalangeal (MCP) joint extension contracture, proximal interphalangeal (PIPJ) joint flexion contracture, and thumb web contracture. These are the positions that patients find to be most comfortable for resting their hands after injury. To prevent further stiffening of the finger joints, intermittent regimes of active and passive mobilization together with the application of splinting are the vital measures. Unless the swelling of the hand and fingers are under control, beneficial effects from mobilization and splinting can hardly be maximized.Edema control is the most prioritized measure in tackling stiff joint problems. Elevation, active mobilization of the involved and the adjacent uninvolved joints, manual massage and compression by elastic wraps or pressure garment can effectively reduce the acute pitting edema. Moreover, splinting the edematous hand is indispensible to maintain the optimal length of tissues and prevent the loss of range of motion through rest and compression. It is important to preserve the length of the MCPJs and IPJs collateral ligaments by keeping these tissues taut through positioning the MCPJs joints in full flexion and the IPJs in full extension. To maintain the length of the flexor tendons, MCPJs flexion should be balanced with wrist extension to take up the slack in the flexor tendons. Active movement of the hand encourages pumping action of the muscle and the subsequent gliding of the soft tissue structures. This facilitates restoring the normal strength of the motor unit of the hand, while at the same time getting more space for the joint to flex and extend through gradual decrease of edematous fluid. Passive movement is the movement of a joint by an external force. Correct passive movement of the joint can encourage tissues to reach a maximum available length. Intermittent passive movement of the affected joint(s) within patients pain tolerances followed by active movement at end ranges of exertion attempts to restore the maximum gliding of the tendons at their maximum length, improving the ranges of motion. The only acceptable clinical method we have of accelerating the modification of scar tissue is the application of stress to the scar. Stretch through stress represents a passive action which results in elongation of the elastic elements of various tissues. Splints are applied to provide low-load prolonged stress a mechanical stimulus that causes the scar to biologically re-model into a form conducive to motion. Either static or dynamic splints are designed to maximize the amount of stress applied to the offending scar while minimizing damage to normal hand tissues. The force applied should be small and constant (low-load prolonged stretch) within a given period of time, which was more effective than high-load brief stretch in order to position the shortened tissue at or near the end of its currently available length. In order to watch for joints stiffening, patients progress should be well documented and regularly reviewed. Objective review such as the range of motion and the severity of swelling, especially during the acute phase, provides the information on how fingers respond to gentle active mobilization program and swelling control measures. However, only manual manipulation of the involved joint(s) gives the clearest feedback indicating the need for passive stretching and splint application. Choice of splinting should be problem-focused at different stages of tissue healing. Alternative day and night splints can maximize the work done for the whole integrative mobilization and splinting program. The more the joints become stiff, the longer the time the tissues should spend at their end ranges through splinting in order to improve the passive range of joint motion. Moreover, patients psychological responses to their trauma are also influential to their functional recovery. For instance, minor trauma to the involved finger can result in joint stiffness if the patients are extremely withdrawn and cannot manage due to some psychological worries. Therefore, to manage the stiff finger joints or hand is not only a matter of “competition between the pace of prioritized treatment and the growth of scar tissues, but it is also a matter of psychological reassurance to the patients, and the close relationship between the therapist and patient as a whole.”啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊