内外侧联合入路治疗创伤性肘关节僵硬  

Open release for post-traumatic stiff elbow with combined medial-lateral approaches

作　　者：李连欣[1] 陶扶林 周东生[1] 郝振海[1] 王永会[1] 徐鹏[1] 

机构地区：[1]山东大学附属省立医院骨科,济南250021

出　　处：《中华肩肘外科电子杂志》2016年第2期93-98,共6页Chinese Journal of Shoulder and Elbow(Electronic Edition)

基　　金：山东科技发展计划(2014GSF118098)

摘　　要：目的：探讨内外侧联合入路肘部松解治疗创伤性肘关节僵硬的手术技巧及临床效果。方法回顾性分析自2009年1月至2014年1月山东省立医院采用内外侧联合入路肘部松解治疗的创伤性肘关节僵硬患者42例,其中男23例、女19例,年龄20～63岁,平均为36.5岁。原始损伤：肱骨髁上骨折5例,肱骨内侧髁骨折3例,肱骨外侧髁骨折4例,髁间骨折6例,尺骨鹰嘴骨折6例,冠状突骨折2例,桡骨小头骨折10例,单纯肘关节脱位4例,不伴有骨折或脱位的软组织损伤2例。手术方法：采用静脉全身麻醉或臂丛麻醉,肘关节内外侧联合切口,彻底松解,25例加用肘关节铰链支架,术后口服消炎痛25 mg,1天3次,持续6周,第2天即开始功能锻炼,8～12周去除外固定架。结果40例患者获得随访,随访时间12～36个月,平均16个月。肘关节屈伸活动度从术前平均36°提高到术后最近复查的105°,肘部功能根据 Mayo 评分由术前平均50分增加到87分,患者手术前后的关节功能相比,差异有统计学意义（P 〈0.05）。结论内外侧联合入路可以彻底切除影响肘关节活动的骨赘、瘢痕、关节囊以及部分韧带,松解关节,加用肘关节铰链支架可以稳定肘关节,增加肘关节间隙,有助于早期活动及功能锻炼,从而获得良好临床效果。Background Elbow stiffness seriously affects patients′daily activities and trauma is the main cause of elbow stiffness.The therapeutic goal of this condition is to get a painless,well-functioned and stable elbow.With in-depth studies in biomechanics of the elbow,improvement of surgical approaches and surgical instrument, and standardization of postoperative rehabilitation protocols,surgical release has become a relatively good choice for elbow stiffness after failed conservative therapies.Due to the complex causes of elbow stiffness,surgical release methods also vary.How to choose an appropriate surgical approach for improved surgical results is worthy of further exploration.We used combined medial and lateral surgical approach to perform surgical release of traumatic elbow stiffness,and applied hinged external fixator in patients with postoperative elbow instability.With proper postoperative exercise,patients achieved satisfactory results,as reported below.Methods Our hospital treated 42 cases of traumatic elbow stiffness patients with combined medial and lateral surgical approach from January 2009 to January 2014,including 23 males and 1 9 females,aged 20-63 years old,with an average age of 36.5 years old.Primary injury：5 cases of supracondylar fracture,3 cases of medial humeral condyle fracture,4 cases of lateral humeral condyle fracture,6 cases of intercondylar fracture,6 cases of olecranon fracture,2 cases of coronoid process fracture,10 cases of radial head fracture,4 cases of simple elbow dislocation,and 2 cases of soft tissue injury without fracture or dislocation.All fractures were clinically healed,but elbow stiffness＆amp;nbsp;was not improved after functional exercise,physical therapy and other conservative treatment.There were different degrees of elbow pain,seriously affecting daily life of the patients.Average time from trauma to surgical release was 1 6 months （6-37 months）.Surgical methods：all patients received combined medial and lateral approach.Lateral approach：cut at 4-5 cm above

关 键 词：肘关节僵硬 创伤 联合入路 铰链外固定架 

分 类 号：R687.4[医药卫生—骨科学]