Takagi Takehiko, Seki Atsuhito, Kobayashi Yuka, Mochida Joji, Takayama Shinichiro
1 Department of Orthopaedic Surgery, Surgical Science, Tokai University School of Medicine, Kanagawa, Japan.
† Department of Orthopaedic Surgery, National Center for Child Health and Development, Tokyo, Japan.
J Hand Surg Asian Pac Vol. 2016 Feb;21(1):44-8. doi: 10.1142/S2424835516500053.
Arthrogryposis is the general term given to conditions characterized by multiple joint contractures resulting in substantial disability most frequently involving a child. Early muscle transfer reconstructive surgery reliably restores elbow flexion. In the present study, we aimed to determine which preoperative condition is best able to restore elbow flexion in patients with arthrogryposis.
We retrospectively reviewed five children (seven cases) who underwent elbow flexor reconstruction (Steindler flexorplasty, four cases; latissimus dorsi transfer, two cases; pectoralis major transfer, one case). Upper-extremity function was assessed on the basis of range of elbow extension and flexion and elbow flexor muscle power pre- and postoperatively.
The mean postoperative active flexion and extension range of motion was 82.1° (60° to 100°) and -15.0° (-40° to 0°) respectively. Mean postoperative elbow flexor muscle power was graded as a 3.4 (2 to 4) as measured with the Medical Research Council (MRC) scale. The preoperative passive elbow flexion angle was found to correlate with postoperative muscle power (MRC) (r = 0.830, p = 0.042) and postoperative active elbow flexion angle (r = 0.902, p = 0.027). Age at operation was not found to correlate with postoperative muscle power (MRC) (r = -0.063, p = 0.878) or active elbow flexion angle (r = -0.134, p = 0.743).
We found a positive correlation between preoperative passive elbow flexion/range of elbow motion and postoperative results including active range of motion and transferred muscle power. Diminished preoperative elbow flexion appeared to correlate with having a poor outcome. The present results suggest that choosing another muscle, such as the gracilis, may be beneficial for muscle transfer in more severe cases of arthrogryposis.
先天性多发性关节挛缩症是一个通用术语，用于描述以多个关节挛缩为特征的病症，这些病症常导致严重残疾，多见于儿童。早期肌肉转移重建手术能够可靠地恢复肘关节屈曲功能。在本研究中，我们旨在确定哪种术前状况最有利于恢复先天性多发性关节挛缩症患者的肘关节屈曲功能。
我们回顾性分析了5名儿童（7例），他们接受了屈肘肌重建手术（施泰德勒屈肌成形术4例；背阔肌转移术2例；胸大肌转移术1例）。根据术前和术后肘关节屈伸范围以及屈肘肌力量评估上肢功能。
术后平均主动屈伸活动范围分别为82.1°（60°至100°）和 -15.0°（-40°至0°）。术后屈肘肌平均力量根据医学研究委员会（MRC）量表评定为3.4级（2至4级）。术前被动肘关节屈曲角度与术后肌肉力量（MRC）（r = 0.830，p = 0.042）和术后主动肘关节屈曲角度（r = 0.902，p = 0.027）相关。未发现手术年龄与术后肌肉力量（MRC）（r = -0.063，p = 0.878）或主动肘关节屈曲角度（r = -0.134，p = 0.743）相关。
我们发现术前被动肘关节屈曲/肘关节活动范围与术后结果（包括主动活动范围和转移肌肉力量）之间存在正相关。术前肘关节屈曲减少似乎与预后不良相关。目前的结果表明，在先天性多发性关节挛缩症更严重的病例中，选择另一种肌肉，如股薄肌，可能有利于肌肉转移。
