Goverman Jeremy, Mathews Katie, Goldstein Richard, Holavanahalli Radha, Kowalske Karen, Esselman Peter, Gibran Nicole, Suman Oscar, Herndon David, Ryan Colleen M, Schneider Jeffrey C
From the *Division of Burns, Department of Surgery, Sumner Redstone Burn Center, Surgical Services, Massachusetts General Hospital, Boston; †Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital, Boston, Massachusetts; ‡Harvard Medical School, Boston, Massachusetts; §Shriners Hospitals for Children, Boston, Massachusetts; ‖Department of Physical Medicine and Rehabilitation, University of Texas Southwestern Medical Center, Dallas; ¶Department of Surgery, University of Washington Medicine Regional Burn Center, University of Washington, Seattle; and #University of Texas Medical Branch, Shriners Hospitals for Children, Galveston.
J Burn Care Res. 2017 Jan/Feb;38(1):e192-e199. doi: 10.1097/BCR.0000000000000341.
Joint contractures are a major cause of morbidity and functional deficit. The incidence of postburn contractures and their associated risk factors in the pediatric population has not yet been reported. This study examines the incidence and severity of contractures in a large, multicenter, pediatric burn population. Associated risk factors for the development of contractures are determined. Data from the National Institute on Disability and Rehabilitation Research Burn Model System database, for pediatric (younger than 18 years) burn survivors from 1994 to 2003, were analyzed. Demographic and medical data were collected on each subject. The primary outcome measures included the presence of contractures, number of contractures per patient, and severity of contractures at each of nine locations (shoulder, elbow, hip, knee, ankle, wrist, neck, lumbar, and thoracic) at time of hospital discharge. Regression analysis was performed to determine predictors of the presence, severity, and numbers of contractures, with P < .05 used for statistical significance. Of the 1031 study patients, 237 (23%) developed at least 1 contracture at hospital discharge. Among those with at least one contracture, the mean was three (3.3) contractures per person. The shoulder was the most frequently contracted joint (27.9%), followed by the elbow (17.6%), wrist (14.2%), knee (13.3%), and ankle (11.9%). Most contractures were mild (38.5%) or moderate (36.3%) in severity. The statistically significant predictors of contracture development were age and intensive care unit (ICU) length of stay. The statistically significant predictors of severity of contracture were age, ICU length of stay, presence of amputation, and black race. Predictors of the number of contractures included total age, length of stay, length of ICU stay, presence of amputation, TBSA burned, and TBSA grafted. This is the first study to report the epidemiology of postburn contractures in the pediatric population. Approximately one quarter of children with a major burn injury developed a contracture at hospital discharge, and this could potentially increase as the child grows. Contractures develop despite early therapeutic interventions such as positioning and splinting; therefore, it is essential that we identify novel and more effective prevention strategies.
关节挛缩是发病和功能缺陷的主要原因。儿科人群中烧伤后挛缩的发生率及其相关危险因素尚未见报道。本研究调查了一个大型多中心儿科烧伤人群中挛缩的发生率和严重程度，并确定了挛缩发生的相关危险因素。对1994年至2003年国家残疾与康复研究所烧伤模型系统数据库中18岁以下儿科烧伤幸存者的数据进行了分析，收集了每个受试者的人口统计学和医学数据。主要结局指标包括挛缩的存在情况、每位患者的挛缩数量以及出院时九个部位（肩部、肘部、髋部、膝部、踝部、腕部、颈部、腰部和胸部）每个部位挛缩的严重程度。进行回归分析以确定挛缩存在、严重程度和数量的预测因素，P <.05具有统计学意义。在1031名研究患者中，237名（23%）在出院时出现了至少1处挛缩。在那些至少有一处挛缩的患者中，平均每人有三处（3.3处）挛缩。肩部是最常发生挛缩的关节（27.9%），其次是肘部（17.6%）、腕部（14.2%）、膝部（13.3%）和踝部（11.9%）。大多数挛缩的严重程度为轻度（38.5%）或中度（36.3%）。挛缩发生的统计学显著预测因素是年龄和重症监护病房（ICU）住院时间。挛缩严重程度的统计学显著预测因素是年龄、ICU住院时间、截肢情况和黑人种族。挛缩数量的预测因素包括总年龄、住院时间、ICU住院时间、截肢情况、烧伤总面积和植皮面积。这是第一项报道儿科人群烧伤后挛缩流行病学的研究。大约四分之一的重度烧伤儿童在出院时出现了挛缩，并且随着儿童成长，这种情况可能会增加。尽管进行了早期治疗干预，如体位摆放和夹板固定，但挛缩仍会发生；因此，确定新的、更有效的预防策略至关重要。
