前内侧肌间隙入路松解治疗退变性肘关节僵硬的临床探索  

Anterior Medial Approach in the Treatment of Degenerative Elbow Stiffness

作　　者：李海滨[1] 王铭[1] 杨学桥[1] 刘会欣[1] 郭殿军[1] 邓广明 付洪睿 Li Haibin;Wang Ming;Yang Xueqiao(Department of Orthopaedics,The People's Hospital of Qingxian,Cangzhou 062650,China)

机构地区：[1]青县人民医院骨关节科,河北沧州062650

出　　处：《实用骨科杂志》2020年第9期774-777,共4页Journal of Practical Orthopaedics

摘　　要：目的探讨前内侧肌间隙入路松解治疗退变性肘关节僵硬的临床疗效。方法2016年8月至2019年8月期间,我科经肘关节前内侧旋前圆肌、桡侧腕屈肌间隙入路进行松解治疗退变性肘关节僵硬19例。其中男15例,女4例;年龄43~62岁,平均(53.6±1.2)岁。右肘13例,左肘6例;15例为主力侧;合并尺神经卡压症状11例。病程4个月~5年,平均(3.5±0.5)年。术后指导康复锻炼,使用Mayo肘关节功能评分(mayo elbow performance score,MEPS)、视觉模拟评分(visual analogue scale,VAS)进行疗效评价。结果19例均获得随访,随访时间3~24个月,平均(11.3±0.8)个月。19例切口均Ⅰ期愈合。术后3个月的MEPS及VAS评分与术前比较,差异有统计学意义(P<0.001)。MEPS评分优11例,良6例,可2例,优良率89.47%。肘关节屈曲角度增至(127.63±5.79)°,伸直受限改善至(9.74±3.90)°,与术前(101.21±12.45)°、(27.63±8.72)°比较差异有统计学意义(P<0.001)。所有患者的前臂旋转也明显改善。屈伸弧度平均增加(44.37±12.09)°,所有患者运动功能都可满足日常生活。除1例术前无尺神经症状的患者,术后出现短暂尺神经麻痹,经保守治疗已治愈外,无其他严重的并发症发生。结论经肘前内侧肌间隙入路治疗退变性肘关节僵硬,是一种安全、有效的方法。而且学习曲线短,手术风险低,较易于在各级医院开展。Objective To explore the clinical application of the anteromedial approach in the treatment of degenerative elbow stiffness.Methods From August 2016 to August 2019,19 cases of degenerative elbow stiffness were treated using the anteromedial elbow approach through the intramuscular space between the pronator teres and the flexor carpiradialis.There were 15 males and 4 females,aged 43~62 years,with an average age of(53.6±1.2)years.There were 13 cases of right elbow and 6 of left,in which 15 cases were the main side,and 11 cases combined with ulnar nerve compression symptoms.The course of disease ranged from 4 months to 5 years,with an average of(3.5±0.5)years.Rehabilitation exercise was guided postoperation,and the curative effect was evaluated using Mayo elbow performance score(MEPS)and VAS score.Results The wounds healed by first intention in all 19 cases.The average follow-up time was(11.3±0.8)months(3 to 24 months),and all 19 cases were followed up.3 months after surgery,the MEPS and VAS score were both statistically significant compared to that preoperative(P<0.001).According tothe MEPS,11 were excellent,6 were good and 2 was fair,andthe cure rate was 89.47%.The flexion increased to(127.63±5.79)°,and the extension restriction improved to(9.74±3.90)°,the difference was statistically significant(P<0.001)compared with(101.21±12.45)°and(27.63±8.72)°preoperative.Forearm rotation was also improved in all cases.In the 3th month follow-up,the mean increase in flexion and extension radians was(44.37±12.09)°,and all patients got a range of motion that could meet the demand in daily life.Except for one patient who had no ulnar nerve compression symptoms preoperative,a transient ulnar nerve palsy occurred after the surgury,which had been cured by conservative treatment.No serious complications occurred.Conclusion The anteromedial approach through the intramuscular space between the pronator teres and the flexor carpi radialis is a reliable and safe access for the treatment of degenerative elbow stiffness.In a

关 键 词：肌间隙入路 退变性 肘关节僵硬 

分 类 号：R684[医药卫生—骨科学]