肘关节完全僵硬21例手术治疗的疗效分析  

Outcome analysis of surgical treatment for 21 cases of elbow ankylosis

作　　者：何宁[1] 欧阳元明[1] 阮洪江[1] 刘珅[1] 范存义[1] 

机构地区：[1]上海交通大学附属第六人民医院骨科,200233

出　　处：《中华手外科杂志》2014年第4期252-255,共4页Chinese Journal of Hand Surgery

摘　　要：目的 探讨关节松解术配合铰链式外固定支架治疗肘关节强直的方法及效果.方法 回顾性分析我院2011年7月至2012年8月收治的肘关节强直患者共21例21肘,其中男13例,女8例;平均年龄41岁.术前患肘均为完全僵硬,关节活动度（ROM）为0°.根据患者具体情况通过取出内固定物、清除异位骨化、松解挛缩软组织及瘢痕、游离松解尺神经等方法,改善患者肘关节活动度并维持肘关节稳定性及血管神经组织的低张力,术后安装铰链式外固定支架,在医生指导下按计划进行严格的功能锻炼,定期随诊,测量术前及术后屈伸活动度并进行Mayo肘关节功能评分（MEPS）,随访并发症发生情况.结果 术后平均随访时间为17.8个月,术后ROM为60° ～ 145°,均值为（120.2±22.3）°,Mayo评分由术前的（64.5±10.8）增至（86.7±11.5）,t=-8.179,P＜0.05,其中优11例、良8例、可1例、差1例.结论 对肘关节强直患者行开放性松解术切除异位骨、清理关节、松解软组织及重建稳定性,术后在铰链式外固定支架辅助下进行功能康复,可以获得较好的治疗效果.Objective To investigate the techniques and outcomes of treating elbow ankylosis with surgical arthrolysis and hinged external fixator.Methods A retrospectively review was conducted to 21 cases of elbow ankylosis treated during July 2011 to August 2012 in our hospital.There were 13 males and 8 females,and the average age was 41 years.The preoperative range of motion （ROM） of all the patients was 0,confirming the diagnosis of complete ankylosis.Removal of internal fixation hard wares,resection of heterotopic ossification,soft tissue release and subcutaneous anterior transposition of the ulnar nerve were performed.The ROM was improved while the stability of elbow joints was maintained,as well as low tension of the neurovascular structures.Hinged external fixator was applied postoperatively to fulfill monitored functional rehabilitation.ROM and Mayo Elbow Performance Score （MEPS） were observed and incidence of complication was recorded.Results The average postoperative follow-up time was 17.8 months.The ROM was 60° to 145°,with an average of （120.2 ± 22.3）°.MEPS improved from （64.5 ± 10.8） to （86.7 ± 11.5）,（t =-8.179,P ＜ 0.05）,with outcomes recognized as excellent in 11 cases,good in 8 cases,fair in 1 case and poor in 1 case.Conclusion Surgical arthrolysis associated with external fixator application and functional rehabilitation can be an effective treatment for elbow ankylosis.

关 键 词：肘关节 外固定器 完全僵硬 外科治疗 

分 类 号：R687.4[医药卫生—骨科学]