Doğumsal Brakiyal Pleksus Yaralanması Olan Çocuklarda Üst Ekstremite Dinlenim Pozisyonunun İncelenmesi

Abstract

Amaç: Çalışmamızın amacı, doğumsal brakiyal pleksus yaralanmalarında (DBPY) farklı sinir yaralanması türlerinde üst ekstremitenin dinlenme pozisyonunu araştırmaktır. Yöntem: Çalışmaya 4-18 yaş aralığında 193 BBPY’li çocuk dahil edildi. Çocukların rutin fizyoterapi değerlendirmelerinin sonuçları retrospektif olarak analiz edildi. Üst ekstremitenin dinlenme pozisyonu ve üst ekstremite fonksiyonu Modifiye Mallet Sınıflandırması kullanılarak değerlendirildi. Narakas tipleri arasında hem global üst ekstremite dinlenme pozisyonu hem de önkol dinlenme pozisyonundaki farklılıklar analiz edildi; ayrıca üst ekstremite dinlenme pozisyonu ile yaş ve fonksiyon arasındaki ilişki araştırıldı. Sonuçlar: Üst ekstremite istirahat pozisyonunun Narakas tiplerine göre dağılımında istatistiksel bir fark vardı (p<0,001). Üst trunkus yaralanmalarında, üst ekstremite istirahat pozisyonu ile üst ekstremite total fonksiyonu arasında orta derecede pozitif bir korelasyon vardı (p<0,01, r=0,60). Ayrıca, total pleksus yaralanması olan çocuklarda yaş ile üst ekstremite istirahat pozisyonu sınıflaması arasında orta derecede negatif bir korelasyon vardı (p<0,01, r= -0,42). Tartışma: Üst trunkus yaralanmalarının tamamında omuz iç rotasyon postürü artışı görülebilemekle birlikte Narakas tip 2b'de daha yaygındı, ayrıca bu durum total üst ekstremite fonksiyonu üzerinde olumsuz bir etkiye sahiptir. Hem total pleksus hem de üst trunkus yaralanmalarında, istirahat önkol postürünün supinasyon veya pronasyonda olabileceği bulunmuştur. Supinasyon pozisyonu, özellikle total pleksus yaralanmalarında ve Narakas tip 2b'de daha yaygındı.

Keywords

• Doğum Yaralanması
• Brakiyal Pleksus
• Postür
• Üst Ekstremite
• Fizyoterapi

Investigation of Upper Extremity Resting Position in Children with Brachial Plexus Birth Injury

Abstract

Purpose: The aim of our study was to investigate the resting position of the upper extremity in different types of nerve injury in brachial plexus birth injury (BPBI). Method: A total of 193 children aged 4-18 years with BPBI were included in the study. The results of the children's routine physiotherapy assessments were analyzed retrospectively. Resting position of the upper extremity and upper extremity function were assessed using the Modified Mallet Classification. Differences in both global upper extremity resting position and forearm resting position between Narakas types were analyzed, and also the relationship between upper limb resting position and age and function was investigated. Results: There was a statistical difference in the distribution of the resting position of the upper extremity according to Narakas types (p<0.001). In upper trunk injuries, there was a moderate positive correlation between upper extremity resting position and total function of the upper extremity (p<0.01, r=0.60). Also, there was a moderate negative correlation between age and grade of the upper extremity resting position in children with total plexus injury (p<0.01, r= -0.42). Discussion: Increased shoulder internal rotation posture could be seen in all upper trunk injuries and was more common in Narakas type 2b, which also has a negative effect on total upper extremity function. It was found that for both total plexus and upper trunk injuries, the resting forearm posture could be in either supination or pronation. Supination position was more common, particularly in total plexus injuries and Narakas type 2b.

Keywords

• Birth Injury
• Brachial Plexus
• Posture
• Upper Extremity
• Physiotherapy

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