应用康复治疗预防产瘫后肩关节内旋挛缩的疗效分析

Rehabilitation in the prevention of medial rotation contracture caused by obstetric brachial plexus palsy

目的 评价康复治疗在预防产瘫后肩关节内旋挛缩畸形中的价值。方法 取初次门诊就诊的 6 3例产瘫患儿 (Tassin1 3型 )作为对照组 ,另 2 0例行上干移植修复的患儿 (Tassin2 4型 )作为康复组 ,比较两组肩关节内旋挛缩的发生率。康复方法 :将处于中立位的双上肢屈肘 90°后外旋到 90° ,再上举到 180°后复原 ,如此往复 ,每天 6次 ,每次 5min。结果 对照组 6 3例共发生肩关节内旋挛缩 2 3例 ,发生率 36 .5 %。其中单纯性肩胛下肌挛缩 17例 ,单纯性肩关节后半脱位 5例 ,复杂性半脱位 1例。康复组 2 0例发生肩关节内旋挛缩 2例———均为单纯性肩胛下肌挛缩 ,发生率 10 %。两组发生率比较有显著的统计学差异 (χ2 =5 .0 5 9,P <0 .0 5 )。结论 康复训练对预防和减轻产瘫后肩关节内旋挛缩的发生具有较重要的价值。

Objective To evaluate the role of rehabilitation in the prevention of medial rotation contracture caused by obstetric brachial plexus palsy. Methods 63 cases with OBPP (Tassin 1-3), who first consulted the doctor in our clinic were studied as the control group; the other 20 cases with OBPP (Tassin 2-4) who had undergone nerve grafting for the upper trunk of the brachial plexus, were studied as the rehabilitation group. Rehabilitation method: The shoulder is set in neutral position, the upper limbs are then externally rotated till 90° and then abducted to 180°. Both arms practiced should be done simultaneously. These gentle stretching movements should be performed for 30 minutes a day (five minutes each, a total of six times). Results 23 out of 63 of the control group had the medial rotation contracture, and the incidence rate was 36.5%. Of these, 17 cases were simple subscapularis muscle contracture, five were simple posterior subluxation, and one was complex posterior dislocation. Two out of 20 of the rehebilitation group had simple subscapularis muscle contracture, and the incidence rate was 10%. There were statistical difference between the two groups ( χ 2=5.059,P<0.05 ). Conclusion Rehabilitation treatment plays an important role in the prevention of medial rotation contacture caused by OBPP.(Shanghai Med J, 2000,23∶714-716)