Molenaar H M Ties, Selles Ruud W, Schreuders Ton A R, Hovius Steven E R, Stam Henk J
Department of Plastic and Reconstructive Surgery, Erasmus MC-University Medical Center Rotterdam, Rotterdam, The Netherlands.
J Hand Surg Am. 2008 Dec;33(10):1796-801. doi: 10.1016/j.jhsa.2008.07.018.
Grip strength and pinch strength measurements are often used to assess hand function. However, both measure a number of muscle groups in combination, and grip strength in particular is dominated by extrinsic hand muscles. The Rotterdam Intrinsic Hand Myometer (RIHM) was recently introduced to measure the force that individual fingers and thumb can exert in different directions. The aim of this study was to establish the reliability of these measurements with use of the RIHM in children.
Sixty-three healthy children between 4 and 12 years of age participated in this study. The RIHM was used to measure thumb palmar abduction, thumb opposition, thumb flexion at the metacarpal-phalangeal (MP) joint, index finger abduction, and little finger abduction. A retest was performed with an average test-retest interval of 26 days.
For the thumb, palmar abduction strength had intraclass correlation coefficients (ICCs) of .98 for both hands. For both thumb opposition and flexion at the MP joint, ICCs were .97 for the dominant hands and .98 for the nondominant hands. Index finger abduction had ICCs of .94 and .95 and little finger abduction had ICCs of .90 and .92 for the dominant and nondominant hands, respectively. The smallest detectable differences for dominant and nondominant hands respectively were thumb palmar abduction, 15% and 15%; thumb opposition, 12% and 9%; thumb flexion (at the MP joint), 12% and 9%; abduction of the index finger, 17% and 17%; and little finger abduction, 26% and 26%.
We found that the RIHM was reliable for use in children. Intraclass correlation coefficients and smallest detectable differences were comparable with those obtained with use of the RIHM in adults and with values found for pinch and grip strength in children. Because the RIHM measures more specific aspects of hand function than grip and pinch, adding the RIHM to measurement protocols may contribute to a more complete overview of a child's hand function.
握力和捏力测量常用于评估手部功能。然而，这两种测量方法都综合测量了多个肌肉群，尤其是握力主要由手部外在肌肉决定。最近引入了鹿特丹手部固有肌肌力计（RIHM）来测量单个手指和拇指在不同方向上所能施加的力。本研究的目的是确定在儿童中使用RIHM进行这些测量的可靠性。
63名4至12岁的健康儿童参与了本研究。使用RIHM测量拇指掌侧外展、拇指对掌、拇指在掌指（MP）关节处的屈曲、食指外展和小指外展。进行了重测，平均重测间隔为26天。
对于拇指，双手的掌侧外展力量组内相关系数（ICC）均为0.98。对于拇指对掌和在MP关节处的屈曲，优势手的ICC为0.97，非优势手的ICC为0.98。食指外展优势手和非优势手的ICC分别为0.94和0.95，小指外展优势手和非优势手的ICC分别为0.90和0.92。优势手和非优势手的最小可检测差异分别为：拇指掌侧外展15%和15%；拇指对掌12%和9%；拇指屈曲（在MP关节处）12%和9%；食指外展17%和17%；小指外展26%和26%。
我们发现RIHM在儿童中使用是可靠的。组内相关系数和最小可检测差异与在成人中使用RIHM获得的结果以及儿童捏力和握力的测量值相当。由于RIHM测量的是手部功能更具体的方面，比握力和捏力更具特异性，因此在测量方案中增加RIHM可能有助于更全面地了解儿童的手部功能。
