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产瘫性臂丛神经麻痹患儿职业治疗干预技术的系统评价与Meta分析

Systematic Review and Meta-Analysis of Intervention Techniques in Occupational Therapy for Babies and Children with Obstetric Brachial Plexus Palsy.

作者信息

Martínez-Carlón-Reina María, Hareau-Bonomi Janine, Rodríguez-Pérez Mª Pilar, Huertas-Hoyas Elisabet

机构信息

Hospital Pediatric Sant Joan. Pg. de Sant Joan de Déu, 2, Esplugues de Llobregat, 08950 Barcelona, Spain.

Head of Hand Therapy Clinic, Montevideo 11600, Uruguay.

出版信息

J Clin Med. 2024 Oct 17;13(20):6186. doi: 10.3390/jcm13206186.

DOI:10.3390/jcm13206186
PMID:39458134
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC11508792/
Abstract

: Obstetric brachial plexus palsy (OBPP) is an unpredictable and unpreventable neurological injury, caused by shoulder dystocia during birth, that affects the brachial plexus and leads to motor and sensory deficits in the child's upper extremity. The limited literature on early therapeutic assessment of newborns with OBPP highlights a gap in specialized care that, if filled, could enhance decision-making and support timely treatment. The objective of this paper is to analyze the therapeutic intervention techniques used at an early stage and their functional impact, from the occupational therapy discipline in the treatment of the upper extremity in babies and children with OBPP. : Systematic review design and meta-analysis. A systematic review is a comprehensive analysis of existing research on a specific topic, using rigorous methods to identify, evaluate, and synthesize studies. Meta-analysis, often part of a systematic review, combines results from multiple studies to identify overall trends and enhance reliability, providing a clearer summary of evidence. Articles that included pediatric patients (from birth to 12 years of age) with a diagnosis of OBPP were reviewed. The results of the techniques used were analyzed according to each study, with the scale or method of assessment considered by the study for the presentation of data. The articles were assessed for methodological quality using the "PEDro Validity Scale". : A total of 2190 articles were found, with 108 analyzed and 22 fully meeting this study's standards. Fourteen had a quantitative design, while the others included clinical guidelines. The most statistically reliable intervention techniques were CIMT (constraint-induced movement therapy) and splinting (dynamic and static), with second-tier techniques like joint manipulation, NMES, early infant management education, and serial casting used when needed. This study focused on children from birth to eight years old, with assessment tools primarily measuring upper limb range of motion, external rotation, supination, and impairment levels, though bimanual activity assessment was less common. : The early implementation of the techniques that provide us with the most data are CIMT, splinting, NMES, and joint manipulation linked to health education for families. In second place, we have the use of TB infiltrations and serial casts, when the treatment of the previous techniques fails in some cases.

摘要

产科臂丛神经麻痹(OBPP)是一种不可预测且无法预防的神经损伤,由分娩时的肩难产引起,影响臂丛神经,导致儿童上肢出现运动和感觉功能障碍。关于新生儿OBPP早期治疗评估的文献有限,这凸显了专科护理方面的差距,若能填补这一差距,可改善决策并支持及时治疗。本文的目的是从职业治疗学科角度分析在治疗患有OBPP的婴幼儿上肢时早期使用的治疗干预技术及其功能影响。

系统评价设计与荟萃分析。系统评价是对特定主题的现有研究进行全面分析,采用严谨方法识别、评估和综合各项研究。荟萃分析通常是系统评价的一部分,它整合多项研究的结果以确定总体趋势并提高可靠性,从而更清晰地总结证据。对纳入诊断为OBPP的儿科患者(从出生到12岁)的文章进行了综述。根据每项研究分析所使用技术的结果,并考虑研究用于呈现数据的评估量表或方法。使用“PEDro效度量表”对文章的方法学质量进行评估。

共检索到2190篇文章,其中108篇进行了分析,22篇完全符合本研究的标准。14篇采用定量设计,其他文章包括临床指南。统计学上最可靠的干预技术是强制性诱导运动疗法(CIMT)和夹板固定(动态和静态),必要时使用关节松动术、神经肌肉电刺激(NMES)、早期婴儿管理教育和系列石膏固定等二线技术。本研究聚焦于出生至8岁的儿童,评估工具主要测量上肢活动范围、外旋、旋后和损伤程度,不过双手活动评估不太常见。

能为我们提供最多数据的技术的早期应用包括CIMT、夹板固定、NMES以及与家庭健康教育相关的关节松动术。其次,在前述技术治疗在某些情况下失败时,会使用经皮穴位电刺激和系列石膏固定。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/2023/11508792/e81d3f6e8539/jcm-13-06186-g003.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/2023/11508792/5101010713d6/jcm-13-06186-g001.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/2023/11508792/45d66417dc66/jcm-13-06186-g002.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/2023/11508792/e81d3f6e8539/jcm-13-06186-g003.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/2023/11508792/5101010713d6/jcm-13-06186-g001.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/2023/11508792/45d66417dc66/jcm-13-06186-g002.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/2023/11508792/e81d3f6e8539/jcm-13-06186-g003.jpg

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本文引用的文献

1
Prevalence of perinatal factors in infants with brachial plexus birth injuries and their association with injury severity.围生期因素在产伤性臂丛神经损伤婴儿中的发生率及其与损伤严重程度的关系。
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Constraint-induced movement therapy for children with neonatal brachial plexus palsy: a randomized crossover trial.约束性诱导运动疗法治疗新生儿臂丛神经麻痹患儿:一项随机交叉试验。
Dev Med Child Neurol. 2021 May;63(5):545-551. doi: 10.1111/dmcn.14741. Epub 2020 Nov 21.
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Onabotulinum toxin type A injection into the triceps unmasks elbow flexion in infant brachial plexus birth palsy: A retrospective observational cohort study.A型肉毒毒素注射入三头肌可揭示婴儿臂丛神经产瘫中的肘关节屈曲:一项回顾性观察队列研究。
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Effectiveness and safety of early intramuscular botulinum toxin injections to prevent shoulder deformity in babies with brachial plexus birth injury (POPB-TOX), a randomised controlled trial: study protocol.早期肌内注射肉毒毒素预防产伤性臂丛神经麻痹婴儿肩部畸形的有效性和安全性(POPB-TOX):一项随机对照试验:研究方案。
BMJ Open. 2019 Sep 30;9(9):e032901. doi: 10.1136/bmjopen-2019-032901.