短指并指畸形患儿及青少年的功能评估：一种单侧手部畸形

Functional Assessment of Children and Adolescents with Symbrachydactyly: A Unilateral Hand Malformation.

作者信息

Goodell Parker B, Bauer Andrea S, Oishi Scott, Arner Marianne, Laurell Tobias, Taylor Sandra L, James Michelle A

机构信息

1Department of Public Health Sciences, Division of Biostatistics (S.L.T), Department of Orthopaedic Surgery (M.A.J.), University of California, Davis, School of Medicine (P.B.G.), Sacramento, California 2Department of Orthopedic Surgery, Boston Children's Hospital, Boston, Massachusetts 3Harvard Medical School, Boston, Massachusetts 4Charles E. Seay, Jr. Hand Center, Texas Scottish Rite Hospital for Children, Dallas, Texas 5Department of Clinical Science and Education (M.A.), Department of Molecular Medicine and Surgery (T.L.), and Center of Molecular Medicine (T.L.), Karolinska Institutet, Stockholm, Sweden 6Department of Hand Surgery (M.A. and T.L.), Södersjukhuset, Stockholm, Sweden 7Department of Orthopaedic Surgery, Shriners Hospitals for Children-Northern California, Sacramento, California.

出版信息

J Bone Joint Surg Am. 2017 Jul 5;99(13):1119-1128. doi: 10.2106/JBJS.16.01283.

DOI:10.2106/JBJS.16.01283

PMID:28678125

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC5490334/

Abstract

BACKGROUND

We studied children and adolescents with symbrachydactyly to determine whether hand function depends on digit opposability and whether scores for function and quality-of-life measures differ from population norms.

METHODS

Participants were grouped on the basis of hand morphology: Group A lacked opposable digits, and Group B had ≥2 digits that were opposable. The groups were compared with each other and with norms with respect to pinch strength, the performance of bimanual activities and in-hand manipulation, and questionnaires regarding psychosocial status and the ability to perform activities of daily living (ADLs). Participants and parents also rated the appearance and function of the hand.

RESULTS

Pinch strength was higher for participants in Group B (4.1 compared with 2.4 kg; p = 0.008), but the groups did not differ with respect to the proportion of participants outside of pinch norms. Participants in Group B were more likely to actively use their affected hand to perform bimanual activities (p ≤ 0.0009), and to use normal or supination strategies to accomplish in-hand manipulation (p = 0.031). The groups did not differ in the proportion of ADLs rated "difficult" or "impossible," and both groups tested within normal limits for psychosocial function. Participants from both groups and their parents rated their satisfaction with hand appearance and function similarly high.

CONCLUSIONS

Participants with ≥2 opposable digits incorporated their hand better in bimanual activities and used more effective strategies to accomplish in-hand manipulation than those who did not. These groups reported no difference in the ability to perform ADLs or with psychosocial function, which was within the normal range. Children and adolescents with symbrachydactyly demonstrated and reported a high level of function in all domains of validated function tests. This study provides information to help parents of children with a unilateral hand malformation understand their child's potential function, and assist surgeons with recommending treatment.

LEVEL OF EVIDENCE

Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.

摘要

背景

我们对患有并指短指畸形的儿童和青少年进行了研究，以确定手部功能是否取决于手指的对掌功能，以及功能评分和生活质量指标是否与人群标准存在差异。

方法

根据手部形态将参与者分组：A组缺乏可对掌的手指，B组有≥2个可对掌的手指。比较两组之间以及与标准在捏力、双手活动和手部操作表现，以及关于心理社会状况和日常生活活动（ADL）能力的问卷方面的差异。参与者和家长还对手部的外观和功能进行了评分。

结果

B组参与者的捏力更高（4.1千克对比2.4千克；p = 0.008），但两组在捏力标准范围外的参与者比例方面没有差异。B组参与者更有可能主动使用患手进行双手活动（p≤0.0009），并使用正常或旋前策略完成手部操作（p = 0.031）。两组在评为“困难”或“不可能”的ADL比例上没有差异，且两组在心理社会功能测试中均在正常范围内。两组的参与者及其家长对手部外观和功能的满意度评分同样高。

结论

与没有可对掌手指的参与者相比，有≥2个可对掌手指的参与者在双手活动中对手部的整合更好，并使用更有效的策略来完成手部操作。这些组在进行ADL的能力或心理社会功能方面没有差异，均在正常范围内。患有并指短指畸形的儿童和青少年在经过验证的功能测试的所有领域都表现并报告了较高的功能水平。本研究提供了信息，以帮助单侧手部畸形儿童的家长了解其孩子的潜在功能，并协助外科医生推荐治疗方案。