Buffart Laurien M, Roebroeck Marij E, Janssen Wim G M, Hoekstra Anneke, Selles Ruud W, Hovius Steven E R, Stam Henk J
Department of Rehabilitation Medicine, Erasmus MC, University Medical Centre Rotterdam, P.O. Box 2040, 3000 CA Rotterdam, The Netherlands.
J Bone Joint Surg Am. 2008 Nov;90(11):2408-15. doi: 10.2106/JBJS.F.00577.
The effects of treatment of children with longitudinal radial deficiency are generally evaluated by measuring grip and pinch strength and joint mobility. Insight into limitations of activities of children with radial deficiency is scarce. In this study, we used standardized instruments to assess impairments in hand function and activity limitations and explored the relationship between the two.
We evaluated the hand function of twenty children with radial deficiency who were between four and twelve years of age. Impairments in hand function were assessed by measuring grip and pinch strength and the active range of motion of the wrist and of the metacarpophalangeal and proximal interphalangeal joints of the second digit. Functional activities were assessed with use of the Assisting Hand Assessment (AHA), to measure the effectiveness of the affected hand, and the Prosthetic Upper Extremity Functional Index (PUFI), to evaluate the ease of activity performance. The relationship between hand function and activity performance and the relationship of those measures with the type of radial deficiency were determined.
The average grip and pinch strengths were 36% and 30% of reference values. We found reductions in the active range of motion, particularly of the metacarpophalangeal and proximal interphalangeal joints. The mean AHA score was 85.5 points and the mean PUFI score was 81.8 points, with both measured on a 0 to 100-point scale. Grip and pinch strength, the active range of joint motion, and the sum scores on the two functional tests were related to the type of radial deficiency. Significant relationships were found between impairments in hand function and activity performance. There was a large variation in the activity performance of the children with poor strength, whereas a more linear relationship was found between the active ranges of motion of the wrist and finger joints and activity performance.
Despite marked impairments in hand function, children with radial deficiency performed functional activities fairly well. Relationships between impairments in hand function and limitation of activities were not linear. We recommend that evaluations of the results of treatment include assessment of both aspects of hand function.
通常通过测量握力、捏力以及关节活动度来评估患有桡骨纵列发育不全儿童的治疗效果。对于桡骨发育不全儿童活动受限情况的了解较为匮乏。在本研究中，我们使用标准化工具来评估手部功能障碍和活动受限情况，并探究两者之间的关系。
我们评估了20名年龄在4至12岁之间的桡骨发育不全儿童的手部功能。通过测量握力、捏力以及腕关节、第二指掌指关节和近端指间关节的主动活动范围来评估手部功能障碍。使用辅助手评估（AHA）来测量患手的有效性，使用上肢假肢功能指数（PUFI）来评估活动执行的难易程度，以此评估功能活动。确定了手部功能与活动表现之间的关系以及这些测量值与桡骨发育不全类型之间的关系。
平均握力和捏力分别为参考值的36%和30%。我们发现主动活动范围有所减小，尤其是掌指关节和近端指间关节。AHA平均得分为85.5分，PUFI平均得分为81.8分，两者均采用0至100分制。握力、捏力、关节活动的主动范围以及两项功能测试的总分与桡骨发育不全的类型有关。手部功能障碍与活动表现之间存在显著关系。力量较差的儿童在活动表现上存在很大差异，而腕关节和手指关节的主动活动范围与活动表现之间的关系则更为线性。
尽管手部功能存在明显障碍，但桡骨发育不全儿童的功能活动表现相当不错。手部功能障碍与活动受限之间的关系并非线性。我们建议治疗结果评估应包括手部功能这两个方面的评估。
