Richards Christopher, Ramirez Rey, Kozin Scott, Zlotolow Dan
Cooper University Hospital, Camden, NJ.
Cooper University Hospital, Camden, NJ.
J Hand Surg Am. 2019 Oct;44(10):898.e1-898.e6. doi: 10.1016/j.jhsa.2018.11.013. Epub 2019 Jan 16.
The goal of this study was to observe the effects of posterior elbow release on children with arthrogryposis at various age points: before the age of 2, between the ages of 2 and 3, and after the age of 3.
This study was a retrospective chart review of patients with arthrogryposis who underwent a posterior elbow release for an elbow extension contracture between 2007 and 2014 at one institution. Eighteen procedures in 13 patients, who had a minimum follow-up of at least 2 years, were included in the study. Patients were divided into 3 groups based on their age at the time of surgery: <2 years old, 2-3 years old, and >3 years old. Comparisons of the pre- and postoperative passive arcs of motion were made.
The average preoperative arc of motion was 16° (0° to 30°) for the children younger than 2, 33.5° (5° to 60°) for the children 2-3, and 45° (25° to 80°) for the children older than 3. The average postoperative arc of motion was 88.2° (70° to 103°), 60° (15° to 85°), and 54.33° (23° to 70°) for the respective age groups. There was a clinically important difference in the postoperative arc of motion between the children less than 2 years old and both the children 2-3 years old and older than 3 years.
This study demonstrates that children who underwent posterior elbow release before the age of 2 had a clinically important increase in their postoperative flexion and overall passive arc of elbow motion compared with older children at medium-term follow-up. The data suggest that earlier release may be better at restoring total passive arc of elbow motion.
TYPE OF STUDY/LEVEL OF EVIDENCE: Therapeutic IV.
本研究的目的是观察不同年龄阶段（2岁前、2至3岁、3岁后）肘关节后路松解术对关节挛缩患儿的影响。
本研究是一项回顾性图表审查，研究对象为2007年至2014年在一家机构因肘关节伸展挛缩接受肘关节后路松解术的关节挛缩患者。纳入了13例患者的18次手术，这些患者的最短随访时间至少为2年。根据手术时的年龄将患者分为3组：<2岁、2至3岁、>3岁。对术前和术后的被动活动弧度进行比较。
2岁以下儿童术前平均活动弧度为16°（0°至30°），2至3岁儿童为33.5°（5°至60°），3岁以上儿童为45°（25°至80°）。各年龄组术后平均活动弧度分别为88.2°（70°至103°）、60°（15°至85°）和54.33°（23°至70°）。2岁以下儿童与2至3岁及3岁以上儿童术后活动弧度存在临床显著差异。
本研究表明，与年龄较大的儿童相比，2岁前接受肘关节后路松解术的儿童在中期随访时术后肘关节屈曲和总体被动活动弧度有临床显著增加。数据表明，早期松解可能更有利于恢复肘关节的总被动活动弧度。
研究类型/证据水平：治疗性IV级。
