Garcia Lauren P, Huang Alice, Corlew Daniel Scott, Aeron Kush, Aeron Yogi, Rai Shankar Man, Jovic Goran, Agag Richard L
From the *Albany Medical College, Albany, NY; †Middle Tennessee Medical Center, Murfreesboro, TN; ‡Helping Hands Hospital; §Uttarakhand Medical & Health Department; ∥ReSurge International, Dehradun, India; ¶National Academy of Medical Sciences; #Kirtipur Hospital; **ReSurge International, Kathmandu, Nepal; ††University Teaching Hospital; ‡‡ReSurge International, Lusaka, Zambia; and §§Albany Medical Center, Albany, NY.
Ann Plast Surg. 2016 Sep;77(3):290-6. doi: 10.1097/SAP.0000000000000856.
Burn contractures hinder joint mobility, resulting in functional impairment and reduced quality of life. This is of greater significance in developing countries where there are fewer resources for assistance with such impairments. Contracture release reduces deformity, but multiple factors affect the extent of postsurgical improvements and outcomes. Elucidating these factors may enable surgeons to better care for burn patients. This study assesses factors that impact burn contracture resolution in developing nations.
A retrospective review of 2506 burn contractures was performed using information extracted from a large nongovernment organization (ReSurge International) database from Nepal, India, and Zambia. Data points included age, type of burn, time elapsed between injury and release, and extent of final release achieved based on preoperative and postoperative images of hand (n = 1960), elbow (n = 371), and knee (n = 176) contractures. Hand improvement was scored based on digit/wrist involvement (severity of dysfunction) and joint extension capability (functionality); elbow and knee improvement were calculated using preoperative and postoperative joint angles. Multivariate analysis was performed.
Hands burned by hot liquid had greater functionality after surgery than open-fire burns (P < 0.01). Improvement in severity of dysfunction and functionality were inversely correlated to age (P < 0.01) and time until surgery (P < 0.01). Elbow improvement decreased as age increased (P < 0.01). Postoperative increase of knee extension decreased for each year elapsed between injury and surgery (P < 0.01).
Burn type, age when burned, and timing of surgery were significant factors affecting hand outcomes, whereas age affected elbow outcomes, and time elapsed until surgery affected knee results. An algorithm was formulated to enable physicians in developing countries with limited resources to triage patients and optimize patient outcomes.
烧伤挛缩会阻碍关节活动，导致功能障碍并降低生活质量。在资源较少、难以对这类损伤提供援助的发展中国家，这一问题更为突出。挛缩松解术可减少畸形，但多种因素会影响术后改善程度和效果。阐明这些因素或许能让外科医生更好地护理烧伤患者。本研究评估了影响发展中国家烧伤挛缩松解效果的因素。
利用从尼泊尔、印度和赞比亚的一个大型非政府组织（国际重建外科组织）数据库中提取的信息，对2506例烧伤挛缩病例进行了回顾性分析。数据点包括年龄、烧伤类型、受伤至松解的时间间隔，以及根据手部（n = 1960）、肘部（n = 371）和膝部（n = 176）挛缩的术前和术后图像得出的最终松解程度。手部改善情况根据手指/腕部受累程度（功能障碍严重程度）和关节伸展能力（功能）进行评分；肘部和膝部改善情况通过术前和术后关节角度计算得出。进行了多变量分析。
热液烫伤的手部术后功能比明火烧伤的手部更好（P < 0.01）。功能障碍严重程度和功能的改善与年龄（P < 0.01）及手术前时间（P < 0.01）呈负相关。随着年龄增长，肘部改善程度降低（P < 0.01）。受伤至手术之间每过去一年，术后膝关节伸展增加量就会减少（P < 0.01）。
烧伤类型、烧伤时年龄和手术时机是影响手部治疗效果的重要因素，年龄影响肘部治疗效果，而受伤至手术的时间间隔影响膝部治疗效果。制定了一种算法，以便资源有限的发展中国家的医生对患者进行分类并优化治疗效果。
