Department and Research Institute of Rehabilitation Medicine, Yonsei University College of Medicine, 50 Yonsei-ro, Seodaemun-gu, Seoul 120-752, Republic of Korea.
Res Dev Disabil. 2011 Nov-Dec;32(6):2389-97. doi: 10.1016/j.ridd.2011.07.021. Epub 2011 Aug 6.
The aims of this study were to investigate the nature and extent of upper limb deformities via the use of various classifications, and to analyze the relationship between upper limb deformities and gross motor or upper limb functionality levels. Upper extremity data were collected from 234 children with spastic cerebral palsy (CP) who were admitted to the university hospital for intensive rehabilitation. Upper limb deformities were classified according to the Zancolli classification for finger and wrist extension ability, the Gshwind and Tonkin classification for supination ability, and the House classification for thumb-in-palm deformity. Digital deformity was also classified. Upper limb function was assessed using the Upper Extremity Rating Scale (UERS) and the Upper Limb Physician's Rating Scale (ULPRS). Gross motor function was assessed using the Gross Motor Functional Classification System (GMFCS). Among the 234 children observed, 70.5% had a limitation in forearm supination, and 62.8% had problems with wrist and finger extension in at least one limb. Thumb-in-palm deformity of at least one hand was found in 47.0% of patients. Swan neck deformity was the most common finger deformity. Upper limb functional measures, the ULPRS and the UERS, significantly correlated with the degree of upper limb deformity, as assessed by the Gschwind and Tonkin, Zancolli, and House classifications. Further, the degree of upper limb deformity was significantly related to the GMFCS level in children with bilateral CP, but not in children with unilateral CP. Limitation of forearm supination was the most common upper limb deformity in children with spastic CP. The degree of upper limb deformity significantly affected upper limb function in these children.
本研究旨在通过使用各种分类方法来研究上肢畸形的性质和程度，并分析上肢畸形与粗大运动或上肢功能水平之间的关系。上肢数据采集自 234 名因痉挛性脑瘫（CP）而入住大学医院接受强化康复治疗的儿童。上肢畸形根据 Zancolli 分类法评估手指和手腕伸展能力、Gshwind 和 Tonkin 分类法评估旋后能力、House 分类法评估拇指内收畸形。还对手指畸形进行了分类。上肢功能使用上肢评定量表（UERS）和上肢医师评定量表（ULPRS）进行评估。粗大运动功能使用粗大运动功能分类系统（GMFCS）进行评估。在所观察的 234 名儿童中，70.5%的儿童前臂旋后受限，62.8%的儿童至少一侧手腕和手指伸展存在问题。至少一只手存在拇指内收畸形的患者占 47.0%。天鹅颈畸形是最常见的手指畸形。上肢功能测量值，ULPRS 和 UERS，与 Gschwind 和 Tonkin、Zancolli 和 House 分类法评估的上肢畸形程度显著相关。此外，在双侧 CP 儿童中，上肢畸形程度与 GMFCS 水平显著相关，但在单侧 CP 儿童中则不相关。前臂旋后受限是痉挛性 CP 儿童最常见的上肢畸形。上肢畸形的程度对上肢功能有显著影响。
