Singer Barbara J, Jegasothy Gnanaletchumy M, Singer Kevin P, Allison Garry T, Dunne John W
Centre for Musculoskeletal Studies, School of Surgery & Pathology, University of Western Australia, Perth, Australia.
Arch Phys Med Rehabil. 2004 Sep;85(9):1465-9. doi: 10.1016/j.apmr.2003.08.103.
To examine an adult population undergoing rehabilitation after brain injury to determine the incidence of ankle contracture and factors contributing to the development of this deformity.
Descriptive study
Specialist inpatient neurosurgical rehabilitation unit in Australia.
Patients (N=105) admitted with a new diagnosis of moderate to severe brain injury over a 12-month period.
Not applicable.
Maximal ankle dorsiflexion range and the presence of abnormal muscle tone affecting the lower limb(s) were evaluated at weekly intervals. Ankle contracture was defined as maximal passive range of less than 0 degrees dorsiflexion with the knee in extension. Patients were grouped into 3 muscle tone categories: normal, predominantly spastic, or predominantly dystonic. Age, sex, mechanism and severity of brain injury, time to onset of ankle contracture, total length of hospital stay, and discharge mobility status data were also recorded.
Muscle tone was designated as normal in 68 (64.7%), as spastic in 14 (13.3%), and as dystonic in 23 (21.9%) patients. The incidence of ankle contracture was 16.2% (17/105 cases). Ankle deformity correlated closely with muscle tone category. Of 23 cases with dystonic muscle overactivity, 17 developed contracture at some point between 1 and 16 weeks after brain injury, although no subject with normal tone or spasticity developed the deformity. There was a weak association between the severity of brain injury and development of ankle contracture.
The incidence of ankle contracture was much lower than previously reported. Dystonic overactivity of the plantarflexor and invertor muscles is a major predisposing factor to ankle contracture.
对成年脑损伤康复患者进行检查，以确定踝关节挛缩的发生率以及导致这种畸形发展的因素。
描述性研究
澳大利亚的专科住院神经外科康复单元
在12个月期间新诊断为中度至重度脑损伤的患者（N = 105）
不适用
每周评估一次最大踝关节背屈范围以及影响下肢的异常肌张力情况。踝关节挛缩定义为膝关节伸直时最大被动背屈范围小于0度。患者被分为3种肌张力类别：正常、主要为痉挛性或主要为张力障碍性。还记录了年龄、性别、脑损伤的机制和严重程度、踝关节挛缩出现的时间、住院总时长以及出院时的活动状态数据。
68例（64.7%）患者的肌张力被判定为正常，14例（13.3%）为痉挛性，23例（21.9%）为张力障碍性。踝关节挛缩的发生率为16.2%（17/105例）。踝关节畸形与肌张力类别密切相关。在23例存在张力障碍性肌肉过度活动的患者中，17例在脑损伤后1至16周的某个时间点出现了挛缩，不过肌张力正常或痉挛性的患者均未出现这种畸形。脑损伤的严重程度与踝关节挛缩的发生之间存在弱关联。
踝关节挛缩的发生率远低于先前报道。跖屈肌和内翻肌的张力障碍性过度活动是踝关节挛缩的主要诱发因素。
