van der Sluijs J A, van der Sluijs M J, van de Bunt F, van Ouwerkerk W J R
Department of Orthopaedic Surgery, VU University Medical Center, 1007 MB, Amsterdam, The Netherlands.
Department of Neurosurgery, VU University Medical Center, 1007 MB, Amsterdam, The Netherlands.
J Child Orthop. 2018 Oct 1;12(5):544-549. doi: 10.1302/1863-2548.12.180051.
As in other neuromuscular disorders, both denervation and muscle paresis/imbalance are implicated as aetiological factors for contractures in children with a Brachial Plexus Birth Injury (BPBI). Although both factors are related, it is unclear which factor is dominant. The aim of this study is to assess whether contracture formation in children is predominantly related to denervation or to residual muscle function/imbalance. This might be relevant for understanding contracture formation in other neuromuscular disorders.
A total of 100 children (61 boys; mean age 10.4 years, 4 to 18) with unilateral BPBI were included in this cross-sectional study. Severity of the denervation was classified according to Narakas. Muscle function of flexors and extensors of both elbows was measured (in Newtons) using a hand-held dynamometer and flexion contractures were measured with a goniometer. The relation between denervation, muscle function/muscle balance and flexion contracture was assessed using univariate and multivariate analysis.
Of the children, 57 were Narakas class I, 13 class II and 30 class III. Mean flexion contracture was 25° (90° to -5°). At the affected side the forearm flexion force was 47% and extension force was 67% of the force of the unaffected side. Contractures were more severe in children with higher Narakas classifications (p = 0.001), after neurosurgery (Mann-Whitney U test, p = 0.009) and were related to age (Spearman's Rho = -0.3, p = 0.008) and to paresis of the extensors (Rho = 0.4, p = 0.000). Flexor paresis as a percentage of unaffected side (Rho = 0.06, p = 0.6) and muscle balance had no influence.
In BPBI, elbow contractures are related to the severity of the neurological lesion, not to residual muscle function.
Level II - prognostic study.
与其他神经肌肉疾病一样，去神经支配和肌肉麻痹/失衡均被认为是臂丛神经产伤（BPBI）患儿挛缩的病因。尽管这两个因素相关，但尚不清楚哪个因素起主导作用。本研究的目的是评估儿童挛缩形成主要是与去神经支配有关还是与残余肌肉功能/失衡有关。这可能有助于理解其他神经肌肉疾病中的挛缩形成。
本横断面研究共纳入100例单侧BPBI患儿（61例男孩；平均年龄10.4岁，4至18岁）。根据纳拉卡斯分类法对去神经支配的严重程度进行分类。使用手持测力计测量双肘屈肌和伸肌的肌肉功能（以牛顿为单位），并用角度计测量屈曲挛缩。采用单因素和多因素分析评估去神经支配、肌肉功能/肌肉平衡与屈曲挛缩之间的关系。
患儿中，57例为纳拉卡斯I级，13例为II级，30例为III级。平均屈曲挛缩为25°（90°至 -5°）。在患侧，前臂屈曲力为健侧的47%，伸展力为健侧的67%。纳拉卡斯分类较高的患儿挛缩更严重（p = 0.001），神经外科手术后也更严重（曼-惠特尼U检验，p = 0.009），且与年龄（斯皮尔曼相关系数 = -0.3，p = 0.008）和伸肌麻痹（相关系数 = 0.4，p = 0.000）有关。屈肌麻痹占健侧的百分比（相关系数 = 0.06，p = 0.6）和肌肉平衡无影响。
在BPBI中，肘部挛缩与神经损伤的严重程度有关，而非与残余肌肉功能有关。
II级 - 预后研究。
