创伤后肘关节僵硬前臂旋转受限的影响因素及其手术疗效  

Factors and effect of arthrolysis on forearm rotational limitation caused by post-traumatic elbow stiffness

作　　者：崔志刚[1] 刘克敏[1] 刘四海[1] 王飞[1] 王安庆[1] 

机构地区：[1]首都医科大学康复医学院、中国康复研究中心北京博爱医院骨科,北京100068

出　　处：《中华手外科杂志》2015年第2期99-102,共4页Chinese Journal of Hand Surgery

摘　　要：目的分析创伤后肘关节僵硬前臂旋转受限的相关影响因素，评价肘关节松解术改善前臂旋转功能的效果。方法回顾性分析我院合并前臂旋转受限的肘关节僵硬患者44例（46肘），行肘关节松解术后随访36个月。测量患者术前、术后的肘关节屈伸和前臂旋转角度，采用上肢功能评定表（DASH）进行评分。采用回归分析各因素对术后肘关节旋转角度改善的影响。结果肘关节僵硬前臂旋转受限和上肢功能有相关性；伤后大于12个月手术、使用外固定架与肘关节僵硬术后前臂旋转功能的改善呈负相关。近端尺桡关节融合、异位骨化和内固定阻挡等为前臂旋转功能改善的主要影响因素。肘关节松解术能有效改善前臂旋转功能，提高上肢功能评分。结论肘关节旋转受限严重影响上肢功能。应伤后尽早（〈12个月）行松解手术、减少外固定架固定时间，术中彻底切除近端尺桡关节处的异位骨化、解除内固定的阻挡以及术后配合无痛下专项康复以有利于肘关节僵硬术后旋转功能的改善。Objective To analyze related factors and effect of arthrolysis for forearm rotational limitation caused by post-traumatic elbow stiffness. Methods This is a retrospective case series including 44 patients （46 elbows, with a 36-month follow-up） who received arthrolysis treatment for elbow stiffness in both sagittal and rotational motion plane. Pre- and post-operation motion range of flexion and rotation, as well as the Disabilities of the Ann, Shoulder and Hand （DASH） scores were measured and analyzed orderly. Regression analysis was employed to investigate the relation between rotation motion and related factors. Results Rotational range of motion was related with upper limb function. Improvement in rotational arc of motion is negatively correlated with delay of arthrolysis for patients with more than 12 months delay after injuries and the implantation of external fixator. Synostosis, heterotopic ossification and implant block were major inhibitors of rotation recovery. Elbow arthrolysis was effective in increasing rotational range of motion. More importantly, this gain in range translated to a statistically significant improvement in upper limb function. Conclusion Rotational range of motion would directly affect upper limb function. Surgical treatment sbould be considered within 12 months since primary injuries. Resecting heterotopic ossification, removing implant involved in proximal radial ulnar joints, and performing postoperative special rotational rehabilitation with pain control would avoid stiffness and improve elbow function.

关 键 词：肘关节 外科手术 旋转受限 康复 

分 类 号：R683.41[医药卫生—骨科学]