The University of British Columbia, Vancouver, Canada.
British Columbia Children's Hospital, Vancouver, Canada.
Hand (N Y). 2023 Jan;18(1_suppl):28S-35S. doi: 10.1177/15589447221093673. Epub 2022 Jun 6.
Brachial plexus birth injuries (BPBIs) can often result in functional and cosmetic deficits including, according to a recent scoping review, elbow flexion contractures in up to 48%. A treatment algorithm that includes a custom long-arm orthosis to optimize early glenohumeral joint positioning (Sup-ER protocol) has been shown to improve shoulder range of motion. Although the protocol was not intentionally designed to affect the elbow, this study investigates the prevalence and severity of elbow flexion contractures in children treated with that protocol.
This prospective cross-sectional cohort study examined 16 children aged 4 and older with BPBI severe enough to be treated with the Sup-ER protocol. Passive and active elbow flexion and extension range of motion (ROM) were assessed in both arms. Elbow flexion contractures were defined as > 5 from neutral.
Within the cohort of 16 patients (mean age: 7.0 years, range: 4.5-11.6 years), the mean maximal passive elbow extension was -6.2° in the affected arm and + 5.1° (hyperextension) in the unaffected arm. Zero patients had a severe elbow flexion contracture (>30) and only 6/16 met the lowest threshold definition of elbow flexion contracture (>5), with a mean onset at 22 months of age.
This study suggests an unintended decreased prevalence and severity of elbow flexion contractures in children with more severe BPBI treated with the Sup-ER protocol, relative to published values.
臂丛神经出生损伤 (BPBI) 通常会导致功能和美容缺陷，根据最近的一项范围综述，多达 48%的患者会出现肘部弯曲挛缩。一种包括定制长臂矫形器以优化早期盂肱关节定位的治疗算法（Sup-ER 方案）已被证明可以改善肩部活动范围。尽管该方案并非有意设计来影响肘部，但本研究调查了接受该方案治疗的儿童中肘部弯曲挛缩的发生率和严重程度。
本前瞻性横断面队列研究检查了 16 名年龄在 4 岁及以上、BPBI 严重程度足以接受 Sup-ER 方案治疗的儿童。在双侧手臂中评估被动和主动肘部弯曲和伸展活动范围 (ROM)。肘部弯曲挛缩定义为> 5 度。
在 16 名患者的队列中（平均年龄：7.0 岁，范围：4.5-11.6 岁），受累侧的最大被动肘部伸展平均值为-6.2°，而未受累侧为+5.1°（过伸）。没有 0 名患者有严重的肘部弯曲挛缩 (>30°)，只有 6/16 名患者符合肘部弯曲挛缩的最低阈值定义 (>5°)，平均发病年龄为 22 个月。
与已发表的值相比，本研究表明，在接受 Sup-ER 方案治疗的更严重 BPBI 儿童中，意外地降低了肘部弯曲挛缩的发生率和严重程度。
