Liu David S, Miller Patricia, Rothenberg Anna, Vuillermin Carley, Waters Peter M, Bauer Andrea S
Department of Orthopaedic Surgery, Boston Children's Hospital, Boston, MA.
Department of Orthopaedic Surgery, Atrium Health, Charlotte, NC.
J Pediatr. 2024 Jan;264:113739. doi: 10.1016/j.jpeds.2023.113739. Epub 2023 Sep 17.
To determine if children who present with an elbow flexion contracture (EFC) from brachial plexus birth injury (BPBI) are more likely to develop shoulder contracture and undergo surgical treatment.
Retrospective review of children <2 years of age with BPBI who presented to a single children's hospital from 1993 to 2020. Age, elbow and shoulder range of motion (ROM), imaging measurements, and surgical treatment and outcome were analyzed. Patients with an EFC of ≥10° were included in the study sample. Data from 2445 clinical evaluations (1190 patients) were assessed. The final study cohort included 72 EFC cases matched with 230 non-EFC controls. Three patients lacked sufficient follow-up data.
There were 299 included patients who showed no differences between study and control groups with respect to age, sex, race, ethnicity, or functional score. Patients with EFC had 12° less shoulder range of motion (95% CI, 5°-20°; P < .001) and had 2.5 times the odds of shoulder contracture (OR, 2.5; 95% CI, 1.3-4.7; P = .006). For each additional 5° of EFC, the odds of shoulder contracture increased by 50% (OR, 1.5; 95% CI, 1.2-1.8; P < .001) and odds of shoulder procedure increased by 62% (OR, 1.62; 95% CI, 1.04-2.53; P = .03). Sensitivity of EFC for predicting shoulder contracture was 49% and specificity was 82%.
In patients with BPBI <2 years of age, presence of EFC can be used as a screening tool in identifying shoulder contractures that may otherwise be difficult to assess. Prompt referral should be arranged for evaluation at a BPBI specialty clinic, because delayed presentation risks worsening shoulder contracture and potentially more complicated surgery.
确定因臂丛神经产伤（BPBI）导致肘关节屈曲挛缩（EFC）的儿童是否更易发生肩关节挛缩并接受手术治疗。
对1993年至2020年在一家儿童医院就诊的年龄小于2岁的BPBI儿童进行回顾性研究。分析年龄、肘关节和肩关节活动范围（ROM）、影像学测量结果以及手术治疗情况和结局。EFC≥10°的患者纳入研究样本。评估了来自2445例临床评估（1190例患者）的数据。最终研究队列包括72例EFC病例以及与之匹配的230例非EFC对照。3例患者缺乏足够的随访数据。
纳入研究的299例患者在年龄、性别、种族、民族或功能评分方面，研究组与对照组之间无差异。EFC患者的肩关节活动范围减少12°（95%CI，5°-20°；P<.001），发生肩关节挛缩的几率是对照组的2.5倍（OR，2.5；95%CI，1.3-4.7；P=.006）。EFC每增加5°，肩关节挛缩的几率增加50%（OR，1.5；95%CI，1.2-1.8；P<.001），肩关节手术的几率增加62%（OR，1.62；95%CI，1.04-2.53；P=.03）。EFC预测肩关节挛缩的敏感性为49%，特异性为82%。
在年龄小于2岁的BPBI患者中，EFC的存在可作为一种筛查工具，用于识别那些可能难以评估的肩关节挛缩。应及时安排转诊至BPBI专科诊所进行评估，因为就诊延迟可能会使肩关节挛缩恶化，并可能导致手术更复杂。
