Long-Term Postoperative Outcomes After Axillary Contracture Release in Children With Burns
Long-Term Postoperative Outcomes After Axillary Contracture Release in Children With Burns
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DOI：
10.1097/bcr.0b013e3182331df4
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发表时间：
2012-03
影响因子：
1.4
通讯作者：
M. Sison-Williamson;A. Bagley;T. Palmieri
中科院分区：
文献类型：
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作者：
M. Sison-Williamson;A. Bagley;T. Palmieri
上肢烧伤的儿童经常出现腋窝挛缩，限制活动。手术解除腋窝挛缩以恢复功能。本研究的目的是通过三维运动分析来确定手术解除腋窝挛缩对模拟日常生活活动中上肢运动的长期影响（长达7年）。对10例患者（男9名，女1名）进行运动分析，16例腋窝挛缩，基线时平均年龄10±3岁，平均TBSA烧伤40±15%)，术前、术后1年，以及术后2 ~ 7年（平均3±2年）进行腋窝挛缩减压手术。研究人员分析了三种功能性任务中的动作，包括高伸（从头顶拿东西）、手到头（梳头）和手到后口袋（如厕）。采用双尾配对t检验比较术前和术后评分。手术解除腋窝挛缩增加肩关节活动度，减少代偿运动。在长期随访中保持了改善。在长期随访中，除高伸任务时的肩部屈曲和手背任务时的肩部外展外，所有肩部运动与正常值无显著差异。腋窝挛缩松解术在短期和长期均可改善肩功能。运动分析是一种有价值的方法，可以在烧伤后立即和随后的几年里客观地量化运动模式的变化。
Children with upper extremity burns frequently develop axillary contractures that can restrict movement. Surgical axillary contracture release is performed to restore function. The purpose of this study is to determine the long-term effects (up to 7 years) of surgical axillary contracture release on upper extremity motion during simulated activities of daily living using three-dimensional motion analysis. Motion analysis was conducted on 10 subjects (9 males and 1 female; 16 axillary contractures; mean age 10 ± 3 years at baseline; mean TBSA burn 40 ± 15%) before, 1 year after, and 2 to 7 years (mean 3 ± 2 years) after axillary contracture release with split-thickness skin graft surgery. Movements were analyzed during three functional tasks including high reach (reaching overhead for an object), hand to head (combing hair), and hand to back pocket (toileting). Two-tailed paired t-tests were used to compare presurgical and postsurgical scores. Surgical release of the axillary contracture increased shoulder mobility and decreased compensatory movements. Improvements were maintained at long-term follow-up. All shoulder movements with the exception of shoulder flexion during the high reach task and shoulder abduction during the hand to back task were not significantly different than normal values at long-term follow-up. Axillary contracture release surgery improves shoulder function in the short and long term. Motion analysis is a modality that may prove valuable in objectively quantifying changes in movement patterns immediately and in subsequent years after burn injury.