Grover J, Gellman H, Waters R L
University of Southern California Department of Orthopaedics, Rancho Los Amigos Medical Center, Downey, California 90262, USA.
J Bone Joint Surg Am. 1996 Sep;78(9):1397-400. doi: 10.2106/00004623-199609000-00016.
We studied six patients (twelve upper extremities) who had quadriplegia at the sixth cervical level. Our purpose was to evaluate how the loss of terminal extension of the elbow adversely affected the ability of the patient to perform transfers with a sliding board and so-called depression raises (lifting of the body with use of the extended upper extremities to reduce the pressure on the ischial tuberosities). Function of the triceps muscle was considered to be absent in eight upper extremities and present in four. A flexion contracture of the elbow was simulated with use of a specially fabricated, hinged elbow brace. Terminal extension was progressively limited, in 5-degree increments, until the patient was no longer able to perform the transfer or the depression raise. The mean flexion contracture at which the patient could not perform the transfer or the depression raise was approximately 25 degrees when function of the triceps was absent and approximately 50 degrees when function of the triceps was intact. The results of this study emphasize the importance of maintaining the full range of motion of the elbow in a patient who has high-level quadriplegia. In a patient who has quadriplegia at the sixth cervical level who otherwise would be independent with regard to transfer skills and mobility in bed, a flexion contracture of the elbow of approximately 25 degrees or more can result in the loss of a functional level and render the patient as dependent as one who has quadriplegia at the fifth cervical level.
我们研究了6例第六颈椎水平四肢瘫痪的患者（12个上肢）。我们的目的是评估肘部终末伸展功能丧失如何对患者使用滑板进行转移以及所谓的减压抬升动作（即利用伸展的上肢抬起身体以减轻坐骨结节压力）的能力产生不利影响。在8个上肢中，肱三头肌功能被认为缺失，在4个上肢中存在。使用特制的铰链式肘托模拟肘部的屈曲挛缩。终末伸展逐渐受限，每次增加5度，直到患者无法进行转移或减压抬升动作。当肱三头肌功能缺失时，患者无法进行转移或减压抬升动作时的平均屈曲挛缩角度约为25度；当肱三头肌功能完好时，约为50度。本研究结果强调了在高位四肢瘫痪患者中维持肘部全范围活动的重要性。对于一名第六颈椎水平四肢瘫痪的患者，若其在转移技能和床上活动方面原本可以独立，肘部约25度或更大角度的屈曲挛缩可能导致功能水平丧失，使患者变得如同第五颈椎水平四肢瘫痪的患者一样依赖他人。
