創傷型三角纖維軟骨複合物損傷病人術後復健護理介入之臨床成效

Clinical Outcomes of Rehabilitation Nursing Interventions for Patients Following Traumatic Triangular Fibrocartilage Complex Surgery

背景：三角纖維軟骨複合體（Triangular Fibrocartilage Complex, TFCC）損傷為手腕創傷後常見病變，可能導致腕部疼痛、無力、握力減弱與扭力下降，進而影響手部功能與日常生活活動。然而，目前針對TFCC損傷術後功能恢復之影響因素與復健護理介入成效的實證研究仍然有限，臨床上亦缺乏結構化復健衛教指導，亟需進一步探討相關照護模式與介入措施的成效。
目的：本研究旨在探討TFCC損傷相關危險因子及影響手術後手部功能恢復之相關因素，並評估復健護理介入對功能恢復與復健知識提升之成效。
方法：本研究採類實驗設計，透過便利取樣方式，招募北部某區域教學醫院接受腕關節鏡手術之創傷型TFCC損傷個案，依術後照護方式分為復健護理介入組與常規照護組。介入組於術前除常規照護外，接受一次「三角纖維軟骨受損術後復健運動護理指導」衛教（包含衛教單張、姿勢示範與衛教說明），兩組均於術前、術後第2週、第6週與第3個月進行功能與知識評估。研究工具包含基本資料收集表、「簡易版上肢功能評估問卷」Quick Disabilities of the Arm, Shoulder, and Hand（Quick DASH）、「Mayo腕關節功能評分」Modified Mayo Wrist Score（MMWS）、握力測量與復健運動知識測驗。研究資料以SPSS 25.0進行統計分析，顯著水準設定為p < .05，並採用描述性統計與推論性統計進行比較分析。
結果：共納入49位個案（實驗組26位、對照組23位）完成全程追蹤。分析結果顯示，術前症狀持續時間小於3個月之個案，其術後手部功能恢復顯著較佳（p = .000）。然比較兩組於術後3個月之手部功能恢復指標，包括Quick DASH、MMWS、復健知識分數及握力表現，皆無統計上顯著差異。
結論與臨床建議：針對創傷型TFCC隱窩型損傷個案，無論接受常規護理或復健護理介入，均可於術後3個月內達成手部功能與日常生活能力之明顯改善。雖然復健護理介入組在手部功能恢復上未顯著優於對照組，然研究結果仍顯示結構化復健衛教在增進患者復健知識與提升依從性方面具有潛在價值。建議臨床護理人員可針對術後早期階段提供簡明圖文並重的衛教內容，並結合定期追蹤與個別化指導，以強化病患的復健意識與實踐。未來研究亦可進一步探討不同特徵個案（如年齡、病程長短）對復健介入的反應差異，並延長追蹤期以評估長期功能恢復情形。

Background: Triangular fibrocartilage complex (TFCC) injury is a common wrist pathology after trauma. It may cause pain, weakness, decreased grip strength, and impaired wrist torsion, affecting hand function and daily activities. However, there is limited empirical research on factors influencing postoperative recovery and the effectiveness of rehabilitation nursing interventions. Current clinical practice also lacks standardized rehabilitation education protocols.
Purpose: This study investigated the risk factors for TFCC injuries and factors associated with hand postoperative function recovery. It also evaluated the effects of a rehabilitation nursing intervention on functional outcomes and patient knowledge.
Methods: A quasi-experimental design with convenience sampling was used to recruit patients with traumatic TFCC injuries undergoing wrist arthroscopy at a regional teaching hospital in northern Taiwan. Based on postoperative care, participants were assigned to either an intervention or a control group. The intervention group received standard care plus a one-time session on postoperative rehabilitation, including an educational leaflet, posture demonstration, and verbal instruction. Assessments were conducted before surgery and at 2 weeks, 6 weeks, and 3 months postoperatively. Tools included a demographic and clinical data sheet, the Quick Disabilities of the Arm, Shoulder, and Hand (Quick DASH), Modified Mayo Wrist Score (MMWS), grip strength, and a rehabilitation knowledge test. Data were analyzed using SPSS version 25.0 with significance set at p < .05. Descriptive and inferential statistics were applied for data analysis.
Results: A total of 49 participants completed follow-up (26 in the intervention group and 23 in the control group). Patients with symptoms lasting less than three months showed significantly better hand function recovery (p = .000). No significant differences were observed between groups in Quick DASH, MMWS, knowledge scores, or grip strength at three months.
Conclusion and Clinical Implications: Both standard care and the rehabilitation intervention led to improvements in hand function and daily activity performance within three months. Although no significant differences were found between groups, structured rehabilitation education may enhance patient knowledge and adherence. Clinical nurses are encouraged to provide illustrated educational materials and regular follow-up to support early rehabilitation. Future studies should explore effects across subgroups and assess long-term outcomes.