Prosthesis rejection in children with a unilateral congenital arm defect
Prosthesis rejection in children with a unilateral congenital arm defect
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单侧先天性手臂缺陷儿童的假体排斥反应
DOI：
10.1177/026921559901300308
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发表时间：
1999
影响因子：
3
通讯作者：
M. Poelma
中科院分区：
文献类型：
--
作者：
K. Postema;V. van der Donk;J. van Limbeek;R. Rijken;M. Poelma
目的：了解儿童假体排斥反应的发生率，并探讨其原因。设计：对一组儿童进行横断面研究。单位：荷兰奈梅亨圣马滕斯克里涅克康复中心。对象：1991年9月至1996年12月就诊的32例单侧先天性手臂畸形患儿，年龄0~18岁。方法：对所有儿童和19名儿童(岁)的家长进行问卷调查。结果：11名儿童(34%)拒绝接受假体。生存函数表明，排斥反应可分为三个阶段：0-40个月、40-162个月和162个月后。在第一和最后阶段，拒绝率很高，而在第二阶段，拒绝率很低。2岁后首次试穿似乎与较高的排斥率有关。受试者和父母认为，假体缺乏功能性收益与排斥率的增加显著相关。排斥率的增加与父母的失望、父母对治疗的参与不足以及对情绪和社会指导的不满有关。结论：排斥反应似乎主要发生在两个时期：在提供假体后的3.5年内和使用假体13.5年后，大多数儿童经历青春期。在2岁之前试穿似乎可以减少排斥率。防止父母对假体福利感到失望，并为他们提供充分的参与治疗和适当的指导，这是假体康复的最佳结果所必需的。
Objective: To determine the rate of rejection for prosthetic use in children and to investigate reasons for this rejection. Design: Cross-sectional study of a cohort of children. Setting: Rehabilitation centre, St Maartenskliniek, Nijmegen, the Netherlands. Subjects: Thirty-two children (0–18 years) with a unilateral congenital arm defect who visited the clinic between September 1991 and December 1996. Methods: Parents of all children and 19 children (years) completed a questionnaire. Results: Eleven children (34%) rejected the prosthesis. A survival function shows that the rejection can be characterized by three periods: 0–40 months, 40–162 months and after 162 months. In the first and last period a high rate of rejection is seen, while in the second period a low rate exists. Fitting for the first time after 2 years of age seems to be related with higher rejection rate. Lack of functional gain with the prosthesis, as perceived by the subjects and the parents, is significantly associated with increased rejection rate. Increased rejection rate is associated with the parents' disappointment, insufficient involvement of the parents in treatment, and dissatisfaction pertaining to emotional and social guidance. Conclusions: Rejection seems to occur in two main periods: within 3.5 years after being provided with a prosthesis and after 13.5 years of prosthetic use, when most children experience puberty. Fitting before the age of 2 years seems to reduce rejection rate. Preventing the parents' disappointment about prosthetic benefits as well as providing them with sufficient involvement in treatment and adequate guidance are essential for optimal results of prosthetic rehabilitation.