一例臂丛神经损伤患者的康复
发布日期: 2017-04-26
本科3月收治了一名臂丛神经损伤患者。该患者为中年女性,因右侧“髌骨骨折”行石膏外固定术后休养,拆除石膏后自行拄双腋杖步行训练,但在训练过程中不慎压伤双腋下的臂丛神经出口处,致双上肢运功功能受限、感觉局部缺失。
入院后经专业康复评估,治疗师考虑其存在周围神经损伤、前臂及手部肌群萎缩等问题,针对其病因予以物理因子治疗及神经松动手法训练。经过3周的训练,患者从入院时不能自主穿脱衣物,恢复到可自主洗漱、穿衣、用餐,手部的抓握力量及肩、肘关节的控制都有所增强。
通过这个病例的讨论及总结,我们有以下体会:1.周围神经损伤的康复训练早期效果明显,尤其神经根感觉支配区恢复较快;2.骨折病人的矫形器配置必须有专人指导及评估,包括手杖、腋杖、肘杖的长度都应在治疗师的评估后确定,否则极易造成康复训练过程中的并发损伤;3.康复治疗,评估先行。后期将进一步加强康复评估的推进,包括肌力、感觉、平衡等,细化评估内容,争取做出行业模板。
(运动医学科 陶文静 撰稿)
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