Ho Emily S, Kim Dorothy, Klar Karen, Anthony Alison, Davidge Kristen, Borschel Gregory H, Hopyan Sevan, Clarke Howard M, Wright F Virginia
Division of Plastic and Reconstructive Surgery, The Hospital for Sick Children, Toronto, ON, Canada.
Rehabilitation Sciences Institute, University of Toronto, Toronto, ON, Canada.
J Pediatr Rehabil Med. 2019;12(1):75-86. doi: 10.3233/PRM-180535.
To synthesize the evidence on the prevalence and etiology of elbow flexion contractures secondary to brachial plexus birth injury (BPBI).
Using Arksey and O'Malley's scoping review framework, MEDLINE, EMBASE, PsycINFO, and CINAHL databases were searched, followed by a comprehensive grey literature search. Articles and abstracts of studies of all level of evidence on the prevalence, natural history, clinical presentation, etiology, and treatment of elbow flexion contractures in BPBI were included.
Of the 884 records found, 130 full text articles were reviewed, and 57 records were included. The median prevalence of elbow flexion contracture in BPBI was 48%. The magnitude of the contractures was between 5 and 90 degrees. Contractures > 30 degrees were found in 21% to 36% of children. With recent clinical and lab studies, there is stronger evidence that the contractures are largely due to the effects of denervation causing failure in the growth of the affected flexor muscles, while muscle imbalance, splint positioning, and postural preferences play a smaller role.
The etiology of elbow flexion contractures is multifaceted. The contribution of growth impairment in the affected muscles offers greater understanding as to why maintaining passive range of motion in these contractures can be difficult.
综合臂丛神经产伤（BPBI）继发肘屈曲挛缩的患病率及病因学证据。
采用Arksey和O'Malley的范围综述框架，检索MEDLINE、EMBASE、PsycINFO和CINAHL数据库，随后进行全面的灰色文献检索。纳入关于BPBI中肘屈曲挛缩的患病率、自然史、临床表现、病因学及治疗的所有证据水平的研究文章和摘要。
在检索到的884条记录中，对130篇全文进行了综述，纳入57条记录。BPBI中肘屈曲挛缩的中位患病率为48%。挛缩程度在5至90度之间。21%至36%的儿童挛缩大于30度。近期的临床和实验室研究表明，有更充分的证据表明挛缩主要是由于失神经作用导致受影响的屈肌生长失败，而肌肉失衡、夹板位置和姿势偏好起的作用较小。
肘屈曲挛缩的病因是多方面的。受影响肌肉生长受损的影响有助于更好地理解为何难以维持这些挛缩的被动活动范围。
