Abstract：
Contractures are a frequent consequence of burn injuries, yet our knowledge of associated risk factors is limited. This paper provides an extensive review of relevant literature from both High-Income Countries (HICs) and Low-Middle Income Countries (LMICs). Ninety-four papers (up to June 2019) and eight subsequent publications (up to March 2022) were included, 76% of which were from HICs. The majority of publications were either descriptive studies (4 from HICs, 9 from LMICs) or papers citing putative risk factors (37 from HICs, 10 from LMICs). Seventeen publications (all from HICs) reported on the effects of individual non-surgical therapeutic interventions, often with conflicting results. Two published systematic reviews emphasised the poor quality of evidence available. Only fifteen studies (3 from LMICs) examined potential contracture risk factors with statistical comparisons of outcomes; significant findings from these included demographic, burn, comorbidities, and treatment risk factors. LMIC papers included socioeconomic and healthcare system factors as potential risks for contracture; these were rarely considered in HIC publications. Methodological issues identified from this review of literature included differences in contracture definitions, populations studied, standards of care, joints included and the timing and nature of contracture assessments.This review is the first to collate existing knowledge on risk factors for burn contractures from both HIC and LMIC settings, revealing a surprising lack of robust evidence for many accepted risk factors. In LMICs, where burns are particularly common, universal health provision is lacking and specialist burn care is both scarce and difficult to access; consequently, socioeconomic factors may have more immediate impact on contracture outcomes than specific burn treatments or therapies. Much more work is indicated to fully understand the relative impacts of risk factors in different settings so that context-appropriate contracture prevention strategies can be developed.
摘要：
挛缩是烧伤的常见后果,然而，我们对相关风险因素的了解是有限的。本文对高收入国家（HIC）和中低收入国家（LMICs）的相关文献进行了广泛的回顾。包括94篇论文（截至2019年6月）和8篇后续出版物（截至2022年3月），其中76%来自HIC。大多数出版物要么是描述性研究(4来自HIC，9来自LMICs)或引用推定风险因素的论文(37来自HICs，10来自LMIC）。17份出版物（全部来自HIC）报道了个别非手术治疗干预措施的效果，结果往往相互矛盾。两个已发表的系统评价强调了现有证据的质量差。只有15项研究（来自LMICs的3项）对潜在的挛缩危险因素进行了结果的统计比较；这些研究的重要发现包括人口统计学，燃烧,合并症,和治疗风险因素。LMIC论文包括社会经济和医疗保健系统因素作为挛缩的潜在风险；这些在HIC出版物中很少考虑。从这篇文献综述中发现的方法学问题包括挛缩定义的差异，人口研究，护理标准，包括关节以及挛缩评估的时间和性质。这篇综述是第一个从HIC和LMIC设置中整理有关烧伤挛缩危险因素的现有知识。令人惊讶的是，许多公认的风险因素缺乏有力的证据。在LMICs中，烧伤特别常见的地方，缺乏全民健康提供，专业烧伤护理既稀缺又难以获得；因此，与特定的烧伤治疗或疗法相比,社会经济因素可能对挛缩结局产生更直接的影响.需要进行更多的工作来充分了解不同环境中风险因素的相对影响，以便可以制定适合上下文的挛缩预防策略。
