de Bruin M, van de Giessen M, Vroemen J C, Veeger H E J, Maas M, Strackee S D, Kreulen M
Department of Plastic, Reconstructive, and Hand Surgery, Academic Medical Center, Amsterdam, The Netherlands.
Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands; Department of Intelligent Systems, Faculty of Electrical Engineering, Applied Mathematics and Computer Science, Delft University of Technology, Delft, The Netherlands.
Clin Biomech (Bristol). 2014 Apr;29(4):451-7. doi: 10.1016/j.clinbiomech.2014.01.003. Epub 2014 Jan 15.
The presence of significant forearm bone torsion might affect planning and evaluating treatment regimes in cerebral palsy patients. We aimed to evaluate the influence of longstanding wrist flexion, ulnar deviation, and forearm pronation due to spasticity on the bone geometries of radius and ulna. Furthermore, we aimed to model the hypothetical influence of these deformities on potential maximal moment balance for forearm rotation.
Geometrical measures were determined in hemiplegic cerebral palsy patients (n=5) and healthy controls (n=5). Bilateral differences between the spastic arm and the unaffected side were compared to bilateral differences between the dominant and non-dominant side in the healthy controls. Hypothetical effects of bone torsion on potential maximal forearm rotation moment were calculated using an existing anatomical muscle model.
Patients showed significantly smaller (radius: 41.6%; ulna: 32.9%) and shorter (radius: 9.1%; ulna: 8.4%) forearm bones in the non-dominant arm than in the dominant arm compared to controls (radius: 2.4%; ulna 2.5% and radius: 1.5%; ulna: 1.0% respectively). Furthermore, patients showed a significantly higher torsion angle difference (radius: 24.1°; ulna: 26.2°) in both forearm bones between arms than controls (radius: 2.0°; ulna 1.0°). The model predicted an approximate decrease of 30% of potential maximal supination moment as a consequence of bone torsion.
Torsion in the bones of the spastic forearm is likely to influence potential maximal moment balance and thus forearm rotation function. In clinical practice, bone torsion should be considered when evaluating movement limitations especially in children with longstanding spasticity of the upper extremity.
显著的前臂骨扭转可能会影响脑瘫患者治疗方案的规划和评估。我们旨在评估因痉挛导致的长期腕部屈曲、尺侧偏斜和前臂旋前对桡骨和尺骨骨骼几何形态的影响。此外，我们旨在模拟这些畸形对前臂旋转潜在最大力矩平衡的假设影响。
在偏瘫型脑瘫患者（n = 5）和健康对照者（n = 5）中测定几何参数。将痉挛侧手臂与未受影响侧之间的双侧差异与健康对照者优势侧与非优势侧之间的双侧差异进行比较。使用现有的解剖肌肉模型计算骨扭转对潜在最大前臂旋转力矩的假设影响。
与对照组相比（桡骨分别为2.4%；尺骨为2.5%，以及桡骨为1.5%；尺骨为1.0%），患者非优势侧手臂的前臂骨明显更小（桡骨：41.6%；尺骨：32.9%）且更短（桡骨：9.1%；尺骨：8.4%）。此外，患者双臂之间的两根前臂骨扭转角差异（桡骨：24.1°；尺骨：26.2°）明显高于对照组（桡骨：2.0°；尺骨1.0°）。该模型预测，由于骨扭转，潜在最大旋后力矩将大约降低30%。
痉挛性前臂的骨骼扭转可能会影响潜在的最大力矩平衡，进而影响前臂旋转功能。在临床实践中，评估运动受限情况时应考虑骨扭转，尤其是对于上肢长期痉挛的儿童。
