应用计算机辅助技术关节镜下治疗原发性肘关节骨关节炎伴僵硬的疗效分析  

Effectiveness analysis of computer-aided technology in the treatment of primary elbow osteoarthritis combined with stiffness under arthroscopy

作　　者：毕文智 郭标 许健 崔红林 马炜 杨东强 付鹏飞 刘一军 田进翔 BI Wenzhi;GUO Biao;XU Jian;CUI Honglin;MA Wei;YANG Dongqiang;FU Pengfei;LIU Yijun;TIAN Jinxiang(Department of Orthopedics,Fuyang Hospital Affiliated to Bengbu Medical College(Fuyang People’s Hospital),Fuyang Anhui,236000,P.R.China)

机构地区：[1]蚌埠医学院附属阜阳医院(阜阳市人民医院)骨科,安徽阜阳236000

出　　处：《中国修复重建外科杂志》2022年第3期268-273,共6页Chinese Journal of Reparative and Reconstructive Surgery

基　　金：蚌埠医学院自然科学类项目(BYKY2019229ZD)。

摘　　要：目的探讨应用计算机辅助技术关节镜下治疗原发性肘关节骨关节炎伴僵硬的疗效。方法回顾分析2018年6月—2020年12月收治的32例原发性肘关节骨关节炎伴僵硬患者临床资料。男22例,女10例;年龄31~71岁,平均53.4岁。X线片及三维CT检查示肘关节内均有不同程度骨赘增生,16例存在游离体,7例合并尺神经卡压综合征。症状持续时间3个月~22.5年,中位时间2.5年。术前利用计算机辅助技术模拟肘关节伸直0°位至屈曲140°位,观察骨赘撞击发生位置,并使用3D打印模型显示肘关节前后方撞击骨赘的去除量及范围,以精确指导手术,同时关节镜直视下检查肘关节松解及撞击骨赘去除效果。采用手术前后肘关节疼痛视觉模拟评分(VAS)、Mayo肘关节评分(MEPS)及肘关节活动度(伸直、屈曲及屈伸)评价肘关节功能。结果手术时间50~160 min,平均108 min。32例患者均获随访,随访时间9~18个月,平均12.5个月。2例术后3周因未坚持正规功能锻炼发生关节挛缩;未发生感染、神经系统损伤、关节腔积液、异位骨化等并发症。所有患者肘关节游离体及撞击骨赘去除彻底,功能恢复满意。末次随访时,VAS评分、MEPS评分及肘关节伸直、屈曲、屈伸活动度均较术前显著改善,差异有统计学意义(P<0.05)。结论应用计算机辅助技术关节镜下治疗原发性肘关节骨关节炎伴僵硬,疼痛显著减轻、功能恢复满意,疗效可靠。Objective To explore the effectiveness of computer-aided technology in the treatment of primary elbow osteoarthritis combined with stiffness under arthroscopy.Methods The clinical data of 32 patients with primary elbow osteoarthritis combined with stiffness between June 2018 and December 2020 were retrospectively analyzed.There were 22 males and 10 females with an average age of 53.4 years(range,31-71 years).X-ray film and three-dimensional CT examinations showed osteophytes of varying degrees in the elbow joint.Loose bodies existed in 16 cases,and there were7 cases combined with ulnar nerve entrapment syndrome.The median symptom duration was 2.5 years(range,3 months to 22.5 years).The location of bone impingement from 0°extension to 140°flexion of the elbow joint was simulated by computer-aided technology before operation and a three-dimensional printed model was used to visualize the amount and scope of impinging osteophytes removal from the anterior and posterior elbow joint to accurately guide the operation.Meanwhile,the effect of elbow joint release and impinging osteophytes removal was examined visually under arthroscopy.The visual analogue scale(VAS)score,Mayo elbow performance score(MEPS),and elbow range of motion(extension,flexion,extension and flexion)were compared between before and after operation to evaluate elbow function.Results The mean operation time was 108 minutes(range,50-160 minutes).All 32 patients were followed up 9-18 months with an average of 12.5 months.There was no other complication such as infection,nervous system injury,joint cavity effusion,and heterotopic ossification,except 2 cases with postoperative joint contracture at 3 weeks after operation due to the failure to persist in regular functional exercises.Loose bodies of elbow and impinging osteophytes were removed completely for all patients,and functional recovery was satisfactory.At last follow-up,VAS score,MEPS score,extension,flexion,flexion and extension range of motion significantly improved when compared with preoperativ

关 键 词：计算机辅助技术 3D打印 肘关节镜 原发性骨关节炎 僵硬 

分 类 号：R687.3[医药卫生—骨科学]