恢复肌萎缩症儿童肘关节的主动屈曲：什么年龄做手术更好？

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论证。患有肌萎缩症的儿童前臂不能主动屈曲是上肢最常见的病变，会导致生活自理困难。为了恢复肘关节的主动屈曲，已经提出了许多手术干预措施，将不同供体区域的肌肉移到前臂屈肌的位置（主要是胸大肌和背阔肌），但文献中没有关于这些手术年龄适应症的信息。

目的。本研究旨在确定肌萎缩症患儿接受旨在恢复肘关节主动屈曲的手术干预的最佳年龄。

材料和方法。该研究是一项回顾性研究，中包括61名肌萎缩症患者：其中30名（49%）为女孩， 31名（51%）为男孩。这些儿童于2011年至2020年期间在H. Turner National Medical Research Center for Children's Orthopedics and Trauma Surgery接受治疗。在90个病例中，通过胸大肌或背阔肌的转位，恢复了肘关节的主动屈曲。其中，46人（51.1%）使用胸大肌作为自体移植物， 44人（48.9%）使用背阔肌。所有儿童按年龄分为四组：第一组包括1-3岁儿童（17名患者，占27.9%），第二组包括3-7岁儿童（30名患者，占49.2%），第三组包括7-11岁儿童（8名患者，占13.1%），第四组包括12-18岁儿童（6名患者，占9.8%）。患者在治疗前和手术后6个月或更长时间接受检查。数据的统计处理使用Statistica 10和SAS JMP 11应用软件包进行。平均值和标准差采用M±SD的格式来描述数字量表。

结果。手术时患者的平均年龄为（5.16±3.72）岁，术后随访时间为（41.93±30.13）个月。肘关节屈曲挛缩主要发生在第1-3组患者中（p<0.05）。第1组患者的屈肌力量、肘关节主动屈曲值和肘关节功能等指标的动态变化最大（p<0.05）。与年轻患者相比，第4组患者术后主动屈肘的动力、前臂屈肌力量和肘关节功能均较差（p<0.05）。第3组和第4组儿童的供体肌力低于第1组和第2组儿童（p<0.05）。

结论。通过对肌萎缩症患儿肘关节主动屈曲恢复效果的分析，我们建议在患儿1至3岁时进行此类手术。对这个年龄段的患者来说，采取预防肘关节屈曲挛缩形成的措施，以及旨在建立新的运动定型、提高自理能力的积极保守治疗极为重要。

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作者简介

Olga E. Agranovich

H. Turner National Medical Research Center for Children’s Orthopedics and Trauma Surgery

Email: olga_agranovich@yahoo.com
ORCID iD: 0000-0002-6655-4108
SPIN 代码: 4393-3694
Scopus 作者 ID: 56913386600
Researcher ID: B-3334-2019

MD, PhD, Dr. Sci. (Med.)

俄罗斯联邦, Saint Petersburg

Ekaterina V. Petrova

H. Turner National Medical Research Center for Children’s Orthopedics and Trauma Surgery

Email: pet_kitten@mail.ru
ORCID iD: 0000-0002-1596-3358
SPIN 代码: 2492-1260
Scopus 作者 ID: 57194563255

MD, PhD, Cand. Sci. (Med.)

俄罗斯联邦, Saint Petersburg

Svetlana I. Trofimova

H. Turner National Medical Research Center for Children’s Orthopedics and Trauma Surgery

Email: trofimova_sv@mail.ru
ORCID iD: 0000-0003-2690-7842
SPIN 代码: 5833-6770
Scopus 作者 ID: 57193275907

MD, PhD, Cand. Sci. (Med.)

俄罗斯联邦, Saint Petersburg

Sergey F. Batkin

H. Turner National Medical Research Center for Children’s Orthopedics and Trauma Surgery

Email: sergey-batkin@mail.ru
ORCID iD: 0000-0001-9992-8906
SPIN 代码: 5173-9340

MD, PhD, Cand. Sci. (Med.)

俄罗斯联邦, Saint Petersburg

Evgeniya A. Kochenova

H. Turner National Medical Research Center for Children’s Orthopedics and Trauma Surgery

Email: jsummer84@yandex.ru
ORCID iD: 0000-0001-6231-8450
SPIN 代码: 4346-5431
Scopus 作者 ID: 57193275508

MD, PhD, Cand. Sci. (Med.)

俄罗斯联邦, Saint Petersburg

Vladimir M. Kenis

H. Turner National Medical Research Center for Children’s Orthopedics and Trauma Surgery

Email: kenis@mail.ru
ORCID iD: 0000-0002-7651-8485
SPIN 代码: 5597-8832
Scopus 作者 ID: 36191914200
Researcher ID: K-8112-2013

MD, PhD, Dr. Sci. (Med.), Professor

俄罗斯联邦, Saint Petersburg

Andrey V. Sapogovskiy

H. Turner National Medical Research Center for Children’s Orthopedics and Trauma Surgery

Email: sapogovskiy@gmail.com
ORCID iD: 0000-0002-5762-4477
SPIN 代码: 2068-2102
Scopus 作者 ID: 57193257532

MD, PhD, Cand. Sci. (Med.)

俄罗斯联邦, Saint Petersburg

Evgenii V. Melchenko

H. Turner National Medical Research Center for Children’s Orthopedics and Trauma Surgery

Email: emelchenko@gmail.com
ORCID iD: 0000-0003-1139-5573
SPIN 代码: 1552-8550
Scopus 作者 ID: 55022869800

MD, PhD, Cand. Sci. (Med.)

俄罗斯联邦, Saint Petersburg

Konstantin A. Afonichev

H. Turner National Medical Research Center for Children’s Orthopedics and Trauma Surgery

Email: afonichev@list.ru
ORCID iD: 0000-0002-6460-2567
SPIN 代码: 5965-6506

MD, PhD, Dr. Sci. (Med.)

俄罗斯联邦, Saint Petersburg

Evgeniy D. Blagoveschenskiy

H. Turner National Medical Research Center for Сhildren’s Orthopedics and Trauma Surgery; National Research University “Higher School of Economics”

编辑信件的主要联系方式.
Email: eblagovechensky@hse.ru
ORCID iD: 0000-0002-0955-6633
SPIN 代码: 2811-5723
Scopus 作者 ID: 6506349269
Researcher ID: B-5037-2014

PhD, Cand. Sci. (Biol.)

俄罗斯联邦, Saint Petersburg; Moscow

参考

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2. Fig. 2. Use of the pectoralis major (PM) and latissimus dorsi (LD) muscles in different age groups to restore active flexion in the elbow joint (RUS)

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3. Fig. 1. Strength of donor muscles depending on the patient’s age

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4. Fig. 2. Use of the pectoralis major (PM) and latissimus dorsi (LD) muscles in different age groups to restore active flexion in the elbow joint

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5. Fig. 3. Change over time of “extension deficit” before and after surgery in four age groups

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6. Fig. 4. Change over time of “extension deficit” after surgery in four age groups in percentage

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7. Fig. 5. Change over time of “forearm flexor strength” in four age groups before and after surgery

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8. Fig. 6. Change over time of “forearm flexor strength” after surgery in four age groups in percentage

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9. Fig. 7. Change over time of “active flexion” in four age groups before and after surgery

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10. Fig. 8. Change over time of “active flexion” in four age groups after surgery in percentage

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11. Fig. 9. Change over time of the “scale score” before and after surgery in patients of four age groups

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12. Fig. 10. Change over time of the “scale score” after surgery in patients of four age groups in points

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版权所有 © Agranovich O., Petrova E., Batkin S.F., Kenis V., Sapogovskiy A., Blagoveschenskiy E.D., 2023


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