van der Holst Menno, Vlieland Thea P M Vliet, Meesters Jorit J L, Bekkering W Peter, Nagels Jochem, Nelissen Rob G H H
Department of Orthopaedics and Rehabilitation, Leiden University Medical Center, Leiden, The Netherlands.
Rijnlands Rehabilitation Center, Leiden, The Netherlands.
J Pediatr Rehabil Med. 2015;8(3):187-96. doi: 10.3233/PRM-150332.
Shoulder function in children with Neonatal Brachial Plexus Palsy (NBPP) can be impaired. Functional gain is possible by an internal contracture release and muscle tendon transfer (ICL+MTT) for external rotation. This study evaluates the functional results of this intervention.
Assessments were done pre-operatively and 3, 6 and 12 months thereafter and included joint-mobility (ROM), muscle strength, arm function (Assisting Hand Assessment (AHA) and Mallet-score), Quality of Life (QoL) (Pediatric Outcome Data Collecting Instrument (PODCI)) and parental satisfaction. Changes were examined using Wilcoxon's Signed-Rank test and Cohen's effect size.
Ten children (5 boys) aged 3-10 years who underwent a combined ICL+MTT (mm. Latissimus Dorsi/Teres Major) were included.Active and passive external rotation ROM and muscle strength improved (p < 0.05). Arm function improved according to the Mallet-score (Hand-to-Head, Hand-to-Mouth, External-Rotation) (p < 0.05) and the arm use and pace scales of the AHA (p < 0.05). The PODCI Upper Extremity/Physical Functioning and Global Functioning subscales also showed improvements (p < 0.05). Parents were highly satisfied concerning daily life activities and sports.
ICL+MTT leads to improvement of ROM, strength, arm function, QoL and high parental satisfaction in this studies' patients and is therefore a good intervention to consider in children with NBPP with limited shoulder function.
新生儿臂丛神经麻痹（NBPP）患儿的肩部功能可能受损。通过内收挛缩松解和肌腱转移术（ICL+MTT）实现外旋功能改善是可行的。本研究评估该干预措施的功能效果。
在术前、术后3个月、6个月和12个月进行评估，包括关节活动度（ROM）、肌肉力量、手臂功能（辅助手评估（AHA）和槌状指评分）、生活质量（QoL）（儿童结局数据收集工具（PODCI））和家长满意度。使用Wilcoxon符号秩检验和Cohen效应量来检验变化情况。
纳入10名年龄在3至10岁之间接受ICL+MTT联合手术（背阔肌/大圆肌）的儿童（5名男孩）。主动和被动外旋ROM以及肌肉力量均有所改善（p<0.05）。根据槌状指评分（手至头部、手至口部、外旋），手臂功能得到改善（p<0.05），并且AHA的手臂使用和速度量表也有所改善（p<0.05）。PODCI上肢/身体功能和整体功能子量表也显示出改善（p<0.05）。家长对日常生活活动和运动高度满意。
在本研究的患者中，ICL+MTT可改善ROM、力量、手臂功能、生活质量并提高家长满意度，因此对于肩部功能受限的NBPP患儿是一种值得考虑的良好干预措施。
