烧伤瘢痕挛缩松解手术有效改善关节活动功能范围、残疾状况及生活质量：一项在低收入和中等收入国家进行的长期随访前后队列研究。

Burn scar contracture release surgery effectively improves functional range of motion, disability and quality of life: A pre/post cohort study with long-term follow-up in a Low- and Middle-Income Country.

作者信息

Hendriks T C C, Botman M, de Haas L E M, Mtui G S, Nuwass E Q, Jaspers M E H, Niemeijer A S, Nieuwenhuis M K, Winters H A H, van Zuijlen P P M

机构信息

Department of Plastic, Reconstructive and Hand Surgery, Amsterdam UMC (Location VUmc), Amsterdam, The Netherlands; Haydom Lutheran Hospital, Haydom, Tanzania; Amsterdam Public Health Research Institute, Amsterdam UMC (Location VUmc), Amsterdam, The Netherlands; Global Surgery Amsterdam, The Netherlands; Doctors of the World, The Netherlands.

Department of Plastic, Reconstructive and Hand Surgery, Amsterdam UMC (Location VUmc), Amsterdam, The Netherlands; Amsterdam Public Health Research Institute, Amsterdam UMC (Location VUmc), Amsterdam, The Netherlands; Global Surgery Amsterdam, The Netherlands; Doctors of the World, The Netherlands.

出版信息

Burns. 2021 Sep;47(6):1285-1294. doi: 10.1016/j.burns.2020.12.024. Epub 2021 Jan 7.

DOI:10.1016/j.burns.2020.12.024

PMID:33485727

Abstract

OBJECTIVE

Burn scar contractures limit range of motion (ROM) of joints and have substantial impact on disability and the quality of life (QoL) of patients, particularly in a Low- and Middle-Income Country (LMIC) setting. Studies on the long-term outcome are lacking globally; this study describes the long-term impact of contracture release surgery performed in an LMIC.

METHODS

This is a pre-post cohort study, conducted in a referral hospital in Tanzania. Patients who underwent burn scar contracture release surgery in 2017-2018 were eligible. ROM (goniometry), disability (WHODAS 2.0) and QoL (EQ-5D) were assessed. The ROM data were compared to the ROM that is required to perform activities of daily living without compensation, i.e. functional ROM. Assessments were performed preoperatively and at 1, 3, 6 and 12 months postoperatively.

RESULTS

In total, 44 patients underwent surgery on 115 affected joints. At 12 months, the follow-up rate was 86%. The mean preoperative ROM was 37.3% of functional ROM (SD 31.2). This improved up to 108.7% at 12 months postoperatively (SD 42.0, p < 0.001). Disability-free survival improved from 55% preoperatively to 97% at 12 months (p < 0.001) postoperatively. QoL improved from 0.69 preoperatively, to 0.93 (max 1.0) at 12 months postoperatively (p < 0.001). Patients who regained functional ROM in all affected joints reported significantly less disability (p < 0.001) and higher QoL (p < 0.001) compared to patients without functional ROM.

CONCLUSIONS

Contracture release surgery performed in an LMIC significantly improved functional ROM, disability and QoL. Results showed that regaining a functional joint is associated with less disability and higher QoL.

摘要

目的

烧伤瘢痕挛缩会限制关节活动范围（ROM），对患者的残疾状况和生活质量（QoL）产生重大影响，在低收入和中等收入国家（LMIC）尤其如此。全球缺乏关于长期结果的研究；本研究描述了在低收入和中等收入国家进行的挛缩松解手术的长期影响。

方法

这是一项前后队列研究，在坦桑尼亚的一家转诊医院进行。2017 - 2018年接受烧伤瘢痕挛缩松解手术的患者符合条件。评估了ROM（测角法）、残疾状况（世界卫生组织残疾评定量表2.0版）和生活质量（EQ - 5D）。将ROM数据与无代偿情况下进行日常生活活动所需的ROM（即功能ROM）进行比较。术前以及术后1、3、6和12个月进行评估。

结果

共有44例患者在115个受影响关节上接受了手术。12个月时，随访率为86%。术前ROM的平均值为功能ROM的37.3%（标准差31.2）。术后12个月时提高到108.7%（标准差42.0，p < 0.001）。无残疾生存率从术前的55%提高到术后12个月时的97%（p < 0.001）。生活质量从术前的0.69提高到术后12个月时的0.93（最大值为1.0）（p < 0.001）。与未恢复功能ROM的患者相比，所有受影响关节均恢复功能ROM的患者报告的残疾程度明显更低（p < 0.001），生活质量更高（p < 0.001）。