Richard Reg, Parry Ingrid S, Santos Alexis, Dewey W Scott
From the *Burn Rehabilitation Department, JBSA Fort Sam Houston, Texas; †Research Department, University of California - Davis, Sacramento, California; and ‡Department of Statistics, Pennsylvania State University, University Park.
J Burn Care Res. 2017 Nov/Dec;38(6):e960-e965. doi: 10.1097/BCR.0000000000000529.
Accurate assessment of hand function following a burn is important for patient impairment determination. Goniometric measurement of hand or finger range of motion (ROM) is typically done measuring individual finger joints with the adjacent joint in extension (isolated) or measuring the joints in a fist position (composite). The purpose of this study was to compare if the total flexion motion of the summed angles of the metacarpophalangeal, proximal interphalangeal, and distal interphalangeal joints in burned hands were equal when performed in an isolated vs a composite manner. Passive flexion ROM angles were collected prospectively and measured at the metacarpophalangeal, proximal interphalangeal, and distal interphalangeal with the adjacent joints extended to measure isolated angles and with the adjacent joints fully flexed for composite angles. Thumb joints were excluded. ROM for isolated and composite positions of eight fingers was compared individually and as an aggregate. Finger measurements from 145 adult patients were compared. The study population was predominately male (69%) with a mean age of 41 ± 16.6 years. Mean total burn size was 14.2 ± 13.2%. A total of 739 fingers contributed 2217 joint ROM comparisons. Aggregate analysis of isolated ROM was 235.5° ± 52.1° compared with composite ROM of 226.8° ± 53.2° (P < .0001). Individual fingers showed significant differences between the two measurement methods as well (P ≤ .0040). The methods used to measure hand or finger ROM profoundly influence how hand impairment is reported. Measurement of isolated joint angles results in greater ROM values compared with composite angles, which are often more relevant for functional hand positions. Therefore, composite angles are recommended.
准确评估烧伤后手功能对于确定患者损伤程度很重要。手部或手指活动范围（ROM）的角度测量通常是在相邻关节伸展（孤立状态）时测量单个手指关节，或者在握拳位置（复合状态）测量关节。本研究的目的是比较烧伤手的掌指关节、近端指间关节和远端指间关节的总屈曲角度在孤立测量与复合测量时是否相等。前瞻性收集被动屈曲ROM角度，并在掌指关节、近端指间关节和远端指间关节处测量，相邻关节伸展时测量孤立角度，相邻关节完全屈曲时测量复合角度。拇指关节被排除在外。分别并综合比较八个手指孤立和复合位置的ROM。比较了145例成年患者的手指测量结果。研究人群以男性为主（69%），平均年龄为41±16.6岁。平均烧伤总面积为14.2±13.2%。总共739个手指进行了2217次关节ROM比较。孤立ROM的综合分析为235.5°±52.1°，而复合ROM为226.8°±53.2°（P<.0001）。各个手指在两种测量方法之间也显示出显著差异（P≤.0040）。用于测量手部或手指ROM的方法对手部损伤报告方式有深远影响。与复合角度相比，测量孤立关节角度会得出更大的ROM值，而复合角度通常与手部功能位置更相关。因此，建议采用复合角度。
