{"title":"臂丛神经产伤后幼儿期肘关节屈曲挛缩的发生率和预测因素。","authors":"","doi":"10.1016/j.jht.2023.09.003","DOIUrl":null,"url":null,"abstract":"<div><h3>Background</h3><p><span>Elbow flexion contracture development in school-age children with a </span>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.</p></div><div><h3>Purpose</h3><p>To determine the prevalence and predictors of BPBI elbow flexion contractures during early childhood.</p></div><div><h3>Study Design</h3><p>A retrospective cross-sectional study.</p></div><div><h3>Methods</h3><p>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.</p></div><div><h3>Results</h3><p>Of the 171 children that met inclusion criteria, 87% (<em>n</em> = 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% (<em>n</em> = 38), with mean onset at 13.4 ± 11.0 months. Mean contracture degree was −10.8 ± −6.9 degrees with 76% (<em>n</em><span> = 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 (</span><em>p</em><span> < 0.001). Logistic regression found that low AMS elbow flexion with high elbow extension scores were a significant (</span><em>p <</em> 0.003) predictor of elbow contracture development.</p></div><div><h3>Conclusions</h3><p>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<span> of C5-C6 injury and its effects on elbow flexion contracture development.</span></p></div>","PeriodicalId":54814,"journal":{"name":"Journal of Hand Therapy","volume":null,"pages":null},"PeriodicalIF":2.1000,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Prevalence and predictors of elbow flexion contractures during early childhood following brachial plexus birth injury\",\"authors\":\"\",\"doi\":\"10.1016/j.jht.2023.09.003\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<div><h3>Background</h3><p><span>Elbow flexion contracture development in school-age children with a </span>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.</p></div><div><h3>Purpose</h3><p>To determine the prevalence and predictors of BPBI elbow flexion contractures during early childhood.</p></div><div><h3>Study Design</h3><p>A retrospective cross-sectional study.</p></div><div><h3>Methods</h3><p>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.</p></div><div><h3>Results</h3><p>Of the 171 children that met inclusion criteria, 87% (<em>n</em> = 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% (<em>n</em> = 38), with mean onset at 13.4 ± 11.0 months. Mean contracture degree was −10.8 ± −6.9 degrees with 76% (<em>n</em><span> = 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 (</span><em>p</em><span> < 0.001). Logistic regression found that low AMS elbow flexion with high elbow extension scores were a significant (</span><em>p <</em> 0.003) predictor of elbow contracture development.</p></div><div><h3>Conclusions</h3><p>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<span> of C5-C6 injury and its effects on elbow flexion contracture development.</span></p></div>\",\"PeriodicalId\":54814,\"journal\":{\"name\":\"Journal of Hand Therapy\",\"volume\":null,\"pages\":null},\"PeriodicalIF\":2.1000,\"publicationDate\":\"2024-07-01\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Journal of Hand Therapy\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://www.sciencedirect.com/science/article/pii/S0894113023001308\",\"RegionNum\":4,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q2\",\"JCRName\":\"ORTHOPEDICS\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Journal of Hand Therapy","FirstCategoryId":"3","ListUrlMain":"https://www.sciencedirect.com/science/article/pii/S0894113023001308","RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q2","JCRName":"ORTHOPEDICS","Score":null,"Total":0}
Prevalence and predictors of elbow flexion contractures during early childhood following brachial plexus birth injury
Background
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.
Purpose
To determine the prevalence and predictors of BPBI elbow flexion contractures during early childhood.
Study Design
A retrospective cross-sectional study.
Methods
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.
Results
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.
Conclusions
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.
期刊介绍:
The Journal of Hand Therapy is designed for hand therapists, occupational and physical therapists, and other hand specialists involved in the rehabilitation of disabling hand problems. The Journal functions as a source of education and information by publishing scientific and clinical articles. Regular features include original reports, clinical reviews, case studies, editorials, and book reviews.