产瘫患儿肘部屈肌挛缩的发生率、进展率和治疗方法。
The prevalence, rate of progression, and treatment of elbow flexion contracture in children with brachial plexus birth palsy.
机构信息
School of Medicine, University of California Davis School of Medicine, 4610 X Street, Sacramento, CA 95817, USA.
出版信息
J Bone Joint Surg Am. 2012 Mar 7;94(5):403-9. doi: 10.2106/JBJS.J.00750.
BACKGROUND
Elbow flexion contracture is a well-known complication of brachial plexus birth palsy that adversely affects upper-extremity function. The prevalence, risk factors, and rate of progression of elbow flexion contracture associated with brachial plexus birth palsy have not been established, and the effectiveness of nonoperative treatment involving nighttime splinting or serial casting has not been well studied.
METHODS
The medical records of 319 patients with brachial plexus birth palsy who had been seen at our institution between 1992 and 2009 were retrospectively reviewed to identify patients with an elbow flexion contracture (≥10°). The chi-square test for trend and the Kaplan-Meier estimator were used to evaluate risk factors for contracture, including age, sex, and the extent of brachial plexus involvement. Longitudinal models were used to estimate the rate of contracture progression and the effectiveness of nonoperative treatment.
RESULTS
An elbow flexion contracture was present in 48% (152) of the patients with brachial plexus birth palsy. The median age of onset was 5.1 years (range, 0.25 to 14.8 years). The contracture was ≥30° in 36% (fifty-four) of these 152 patients and was accompanied by a documented radial head dislocation in 6% (nine). The prevalence of contracture increased with increasing age (p < 0.001) but was not significantly associated with sex or with the extent of brachial plexus involvement. The magnitude of the contracture increased by 4.4% per year before treatment (p < 0.01). The magnitude of the contracture decreased by 31% when casting was performed (p < 0.01) but thereafter increased again at the same rate of 4.4% per year. The magnitude of the contracture did not improve when splinting was performed but the rate of increase thereafter decreased to <0.1% per year (p = 0.04).
CONCLUSIONS
The prevalence of elbow flexion contracture in children with brachial plexus birth palsy may be greater than clinicians perceive. The prevalence increased with patient age but was not significantly affected by sex or by the extent of brachial plexus involvement. Serial casting may initially improve severe contractures, whereas nighttime splinting may prevent further progression of milder contractures.
背景
肘屈曲挛缩是臂丛神经产伤后一种常见的并发症，会对上肢功能产生不利影响。臂丛神经产伤后肘屈曲挛缩的发生率、危险因素和进展速度尚未确定，夜间夹板固定或连续石膏固定等非手术治疗的效果也尚未得到很好的研究。
方法
对 1992 年至 2009 年期间在我院就诊的 319 例臂丛神经产伤患儿的病历进行回顾性分析，以确定存在肘屈曲挛缩（≥10°）的患儿。采用趋势卡方检验和 Kaplan-Meier 估计法评估挛缩的危险因素，包括年龄、性别和臂丛神经受累程度。采用纵向模型估计挛缩的进展速度和非手术治疗的效果。
结果
在 319 例臂丛神经产伤患儿中，有 48%（152 例）存在肘屈曲挛缩。发病中位年龄为 5.1 岁（范围：0.25-14.8 岁）。在这 152 例患儿中，有 36%（54 例）的挛缩程度≥30°，有 6%（9 例）伴有桡骨头脱位。挛缩的发生率随年龄的增加而增加（p<0.001），但与性别或臂丛神经受累程度无显著相关性。治疗前，挛缩程度每年增加 4.4%（p<0.01）。进行石膏固定后，挛缩程度可减少 31%（p<0.01），但此后挛缩程度又以相同的 4.4%/年的速度增加。夹板固定后，挛缩程度无改善，但此后增加速度降至<0.1%/年（p=0.04）。
结论
在患有臂丛神经产伤的儿童中，肘屈曲挛缩的发生率可能高于临床医生的认知。其发生率随患儿年龄的增加而增加，但不受性别或臂丛神经受累程度的显著影响。连续石膏固定可使严重的挛缩初始改善，而夜间夹板固定则可防止较轻的挛缩进一步进展。
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