Department of Occupational Science and Occupational Therapy, University of Toronto, Toronto, Canada; Alberta Health Services, Calgary, Canada.
Department of Occupational Science and Occupational Therapy, University of Toronto, Toronto, Canada; Sunnybrook Health Sciences Centre, Toronto, Canada.
J Hand Ther. 2024 Jul-Sep;37(3):446-452. doi: 10.1016/j.jht.2023.09.003. Epub 2024 Feb 10.
Elbow flexion contracture development in school-age children with a brachial plexus birth injury (BPBI) is common. Reports indicate onset between 2 and 4 years; however, little is known about early childhood prevalence, development, and trajectory of these contractures.
To determine the prevalence and predictors of BPBI elbow flexion contractures during early childhood.
A retrospective cross-sectional study.
Demographic, diagnostic, treatment, and elbow contracture data were collected for children with a BPBI <4 years between 2015 and 2019 from a prospectively collected database. Spinal root motor contributions and injury were determined using Active Movement Scale (AMS) scores at 6 weeks of age and used to predict contracture development.
Of the 171 children that met inclusion criteria, 87% (n = 149) had upper plexus injuries. The mean age at the time of evaluation for an elbow contracture was 21.4 ± 12.7 months. The prevalence of elbow flexion contractures was 22% (n = 38), with mean onset at 13.4 ± 11.0 months. Mean contracture degree was -10.8 ± -6.9 degrees with 76% (n = 29) <-10 degrees. AMS shoulder abduction, flexion, and external rotation; elbow flexion; forearm supination; and wrist extension scores at a mean 2.3 ± 1.4 months were significantly lower in children who developed elbow flexion contractures (p < 0.001). Logistic regression found that low AMS elbow flexion with high elbow extension scores were a significant (p < 0.003) predictor of elbow contracture development.
The prevalence of elbow flexion contractures in early childhood is greater than previously understood. These findings indicate that C5-C6 injury affecting elbow flexion with relative preservation of elbow extension is a predictor of contracture development. Further research is needed to investigate the nature and sequelae of C5-C6 injury and its effects on elbow flexion contracture development.
患有臂丛神经出生损伤（BPBI）的学龄儿童常发生肘部弯曲挛缩。报告显示发病时间在 2 至 4 岁之间；然而，对于这些挛缩的幼儿期患病率、发展和轨迹知之甚少。
确定幼儿期 BPBI 肘部弯曲挛缩的患病率和预测因素。
回顾性横断面研究。
从 2015 年至 2019 年，从一个前瞻性收集的数据库中收集了 BPBI<4 岁的儿童的人口统计学、诊断、治疗和肘部挛缩数据。使用 6 周龄时的主动运动量表（AMS）评分确定脊神经根运动贡献和损伤，并用于预测挛缩的发展。
在符合纳入标准的 171 名儿童中，87%（n=149）为上丛神经损伤。评估肘部挛缩时的平均年龄为 21.4±12.7 个月。肘部弯曲挛缩的患病率为 22%（n=38），平均发病时间为 13.4±11.0 个月。平均挛缩程度为-10.8±-6.9 度，其中 76%（n=29）<-10 度。在发生肘部弯曲挛缩的儿童中，AMS 肩外展、前屈和外旋；肘部弯曲；前臂旋后；和手腕伸展评分在平均 2.3±1.4 个月时显著较低（p<0.001）。Logistic 回归发现，低 AMS 肘部弯曲伴高肘部伸展评分是肘部挛缩发展的显著预测因素（p<0.003）。
幼儿期肘部弯曲挛缩的患病率高于先前的理解。这些发现表明，影响肘部弯曲且肘部伸展相对保留的 C5-C6 损伤是挛缩发展的预测因素。需要进一步研究 C5-C6 损伤的性质及其对肘部弯曲挛缩发展的影响。
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