Gong Hyun Sik, Chung Chin Youb, Park Moon Seok, Shin Hyung-Ik, Chung Moon Sang, Baek Goo Hyun
Department of Orthopaedics and Rehabilitation, Seoul National University Bundang Hospital, Seongnam, Korea.
J Hand Surg Am. 2010 Feb;35(2):277-283.e1-3. doi: 10.1016/j.jhsa.2009.10.028.
The heterogeneity of cerebral palsy makes interpretation and prediction of outcome after upper extremity surgery difficult. We hypothesized that the outcome of upper extremity surgery for cerebral palsy is related to the Manual Ability Classification System (MACS) level.
We reviewed 27 patients with a mean age of 22 years, who underwent upper extremity surgery for spastic cerebral palsy at a mean follow-up of 29 months. Patients were classified into 5 MACS levels using a standardized questionnaire completed by their primary caregivers. Preoperatively and at most recent follow-up visits, patients were assessed using the House scale and patient-reported functional outcomes on a 5-point scale. We compared the outcomes of patients with high (I-II, independence in daily activities) and low (III-V, dependence in daily activities) MACS levels.
The overall mean House scale improved from 2.9 to 4.6 postoperatively (p<.001), dressing ability from 3.7 to 4.2 (p=.005), hygiene from 4.2 to 4.9 (p=.005), and appearance from 2.4 to 4.2 (p<.001). A total of 13 patients had a high MACS level (7 had I and 6 had II) and 14 had a low MACS level (8 had III, 6 had IV, and none had V). The high-MACS group had a greater improvement according to the House scale (p=.009) and the low-MACS group had a larger improvement in hygiene status (p=.043). There were no differences in the amount of improvement in dressing ability (p=.169) and appearance (p=.765). Overall satisfaction with surgery was higher for the high-MACS group (p=.038).
The high-MACS group had a greater improvement in rating according to the House scale and higher satisfaction than the low-MACS group after upper extremity surgery for cerebral palsy in our small number of patients. This study suggests that the MACS level can be used to predict upper extremity surgery outcomes for cerebral palsy.
TYPE OF STUDY/LEVEL OF EVIDENCE: Prognostic II.
脑性瘫痪的异质性使得上肢手术后的疗效解读和预测变得困难。我们推测脑性瘫痪上肢手术的疗效与手功能分类系统（MACS）水平有关。
我们回顾了27例平均年龄22岁的患者，他们因痉挛性脑性瘫痪接受了上肢手术，平均随访29个月。通过由其主要照顾者完成的标准化问卷将患者分为5个MACS水平。术前及最近一次随访时，使用豪斯量表对患者进行评估，并采用5分制让患者报告功能结局。我们比较了MACS水平高（I-II级，日常生活自理）和低（III-V级，日常生活依赖他人）的患者的疗效。
术后豪斯量表总体平均分从2.9提高到4.6（p<0.001），穿衣能力从3.7提高到4.2（p=0.005），卫生自理能力从4.2提高到4.9（p=0.005），外观从2.4提高到4.2（p<0.001）。共有13例患者MACS水平高（7例为I级，6例为II级），14例患者MACS水平低（8例为III级，6例为IV级，无V级）。根据豪斯量表，MACS水平高的组改善更大（p=0.009），MACS水平低的组在卫生自理状况方面改善更大（p=0.043）。穿衣能力（p=0.169）和外观（p=0.765）的改善程度无差异。MACS水平高的组对手术的总体满意度更高（p=0.038）。
在我们少量的脑性瘫痪上肢手术患者中，MACS水平高的组在豪斯量表评分上的改善比MACS水平低的组更大，且满意度更高。本研究表明，MACS水平可用于预测脑性瘫痪上肢手术的疗效。
研究类型/证据水平：预后性研究II级。
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