Pontén Eva, Gantelius Stefan, Lieber Richard L
Department of Pediatric Orthopaedics, Astrid Lindgren Children's Hospital, Karolinska University Hospital, Stockholm, Sweden.
Muscle Nerve. 2007 Jul;36(1):47-54. doi: 10.1002/mus.20780.
Children with cerebral palsy often have spasticity of both the extensors and flexors, but how and why a flexion contracture of the wrist will develop during growth is not thoroughly understood. In order to understand the muscle adaptations that occur during contracture formation, the relationship between intraoperative sarcomere length and the extent of contracture was measured in 23 children (average age, 14.3 +/- 2.9 years) undergoing tendon transfers involving the flexor carpi ulnaris (FCU) or extensor carpi radialis brevis (ECRB) muscles. For both ECRB and FCU, sarcomere lengths measured intraoperatively were longer compared to sarcomere lengths predicted from a regression relationship obtained from "control" patients with radial nerve injury (P < 0.001). The most interesting aspect of the long FCU sarcomere lengths measured was that there was a highly significant correlation between the degree of contracture formation and intraoperative sarcomere length (r2 = 0.5, P < 0.005). These data clearly show that greater contracture severity is associated with longer intraoperative FCU sarcomere length. No such correlation was observed for the ECRB. The data suggest that the clinical presentation of the contracture is related to degree of FCU, but not ECRB adaptation, to the central nervous system lesion.
患有脑瘫的儿童通常存在伸肌和屈肌的痉挛，但对于手腕屈曲挛缩在生长过程中如何以及为何会发展，目前尚未完全了解。为了理解挛缩形成过程中发生的肌肉适应性变化，对23名接受涉及尺侧腕屈肌（FCU）或桡侧腕短伸肌（ECRB）肌腱转移手术的儿童（平均年龄14.3±2.9岁）术中肌节长度与挛缩程度之间的关系进行了测量。对于ECRB和FCU，术中测量的肌节长度均长于根据桡神经损伤“对照”患者获得的回归关系预测的肌节长度（P<0.001）。测量得到的FCU肌节长度较长这一最有趣的方面是，挛缩形成程度与术中肌节长度之间存在高度显著的相关性（r2 = 0.5，P<0.005）。这些数据清楚地表明，挛缩严重程度越高，术中FCU肌节长度越长。ECRB未观察到这种相关性。数据表明，挛缩的临床表现与FCU而非ECRB对中枢神经系统病变的适应性程度有关。
