Smith Dean W, Drennan James C
Carrie Tingley Hospital, University of New Mexico Health Sciences Center, 1127 University Boulevard, Albuquerque, NM 87102, U.S.A.
J Pediatr Orthop. 2002 Jan-Feb;22(1):44-7.
Arthrogryposis multiplex congenita involving the upper extremity can be associated with significant contractures of major joints. Treatment options to maximize upper extremity motion and function include passive joint stretching, serial casting, or surgical intervention. This study reviewed all patients at Carrie Tingley Hospital with arthrogrypotic wrist flexion contractures treated with passive stretching, serial casting, and custom wrist orthotics to determine the effect on wrist position and function. Seventeen infant patients with distal and classic arthrogryposis used this regimen. Average follow-up was 6 years. The greatest gain in wrist motion occurred after the first casting session for both groups. Patients with distal arthrogryposis had the largest improvement in passive wrist motion, were more functionally independent at final follow-up, and had no recurrence of deformity. Patients with classic arthrogryposis had rigid wrist flexion contractures and a 75% incidence of deformity recurrence after casting. At final follow-up, these patients remained functionally dependent, requiring >50% assistance with activities of daily living, and had less improvement in wrist motion. The authors recommend early casting of infant wrist deformities for both forms of arthrogryposis. If the wrist deformity recurs, repeat serial casting is unlikely to improve wrist extension. Other treatment options may be considered in the older child.
先天性多发性关节挛缩累及上肢时，可伴有主要关节的严重挛缩。旨在最大化上肢活动度和功能的治疗选择包括被动关节伸展、系列石膏固定或手术干预。本研究回顾了在嘉莉·廷利医院接受被动伸展、系列石膏固定和定制手腕矫形器治疗的所有患有关节挛缩性腕关节屈曲挛缩的患者，以确定其对腕关节位置和功能的影响。17例患有远端型和典型型先天性多发性关节挛缩的婴儿患者采用了该治疗方案。平均随访时间为6年。两组患者在第一次石膏固定后腕关节活动度的改善最为明显。远端型先天性多发性关节挛缩患者的被动腕关节活动度改善最大，在末次随访时功能独立性更强，且畸形无复发。典型型先天性多发性关节挛缩患者存在僵硬的腕关节屈曲挛缩，石膏固定后畸形复发率为75%。在末次随访时，这些患者在功能上仍有依赖，日常生活活动需要超过50%的协助，且腕关节活动度改善较小。作者建议对两种类型的先天性多发性关节挛缩患儿的腕关节畸形尽早进行石膏固定。如果腕关节畸形复发，重复系列石膏固定不太可能改善腕关节伸展。对于年龄较大的儿童，可考虑其他治疗选择。
