创伤性肘关节僵硬的松解治疗  

Release of traumatic elbow stiffness

作　　者：纪振钢 韩天宇 周大鹏 周志斌 宋夏楠 王浩然 宗宇宁 金万通 JI Zhen-gang;HAN Tian-yu;ZHOU Da-peng;ZHOU Zhi-bin;SONG Xia-nan;WANG Hao-ran;ZONG Yu-ning;JIN Wan-tong(Department of Orthopedics,General Hospital of Northern Theater Command,Shenyang Liaoning 110016,China)

机构地区：[1]北部战区总医院骨科,辽宁沈阳110016

出　　处：《局解手术学杂志》2022年第7期619-623,共5页Journal of Regional Anatomy and Operative Surgery

基　　金：辽宁省民生科技计划项目(2021JH2/10300057)。

摘　　要：目的探讨肘关节松解治疗创伤性肘关节僵硬的效果。方法纳入我院18例创伤性肘关节僵硬患者,均采用开放性肘关节松解手术治疗。10例采用内、外侧联合入路,6例采用前次手术的外侧切口入路,2例采用前次手术的后正中切口入路行手术松解。其中10例患者在松解同时进行了尺神经前置。所有患者术后配合康复治疗。评价患者术前及末次随访时肘关节屈伸活动和术后并发症发生情况;根据Mayo肘关节功能评分(MEPS)系统评价患者肘关节功能恢复情况。结果患者术后随访10~39个月,平均19.4个月。末次随访时患者MEPS评分为(89.61±4.59)分,与术前比较差异有统计学意义(P<0.001)。末次随访时患者优良率为88.9%,与术前比较差异具有统计学意义(P<0.001)。末次随访时患者肘关节主动屈伸活动度为(116.94°±5.07°),与术前比较差异有统计学意义(P<0.001)。术后1例患者出现了尺神经症状,药物治疗后好转;1例患者出现肘关节不稳,延长支具固定时间后好转。结论肘关节松解治疗创伤性肘关节僵硬可以明显改善肘关节屈伸活动度,提高患者生活质量。Objective To investigate the effect of elbow release in the treatment of traumatic elbow stiffness.Methods A total of 18 patients with traumatic elbow stiffness in our hospital were included,and all of them were treated with open elbow release surgery.Ten cases adopted the combined medial and lateral approach,6 cases adopted the lateral incision of the previous operation as the approach,and 2 cases used the posterior median incision of the previous operation as the approach for surgical release.Ten of these patients received ulnar nerve preposition during release.All patients were received postoperative rehabilitation treatment.The elbow flexion and extension activities before operation and at the last follow-up and postoperative complications were evaluated.The recovery of elbow function was evaluated according to the Mayo elbow performance score(MEPS).Results The patients were followed up for 10 to 39 months,with an average of 19.4 months.The MEPS score of the patients at the last follow-up was(89.61±4.59)scores,which was significantly different from that before operation(P<0.001).The excellent and good rate was 88.9%at the last follow-up,which was significantly different from that before operation(P<0.001).The active flexion and extension range of motion of the elbow at the last follow-up was(116.94°±5.07°),which was significantly different from that before operation(P<0.001).One patient had ulnar nerve symptoms after operation,which improved after drug treatment;one patient had elbow instability,which improved after prolonged bracing time.Conclusion Elbow release in the treatment of traumatic elbow stiffness can significantly improve elbow flexion and extension range of motion and improve quality of life of patients.

关 键 词：创伤 肘关节僵硬 肘关节不稳定 预防 治疗 

分 类 号：R684.8[医药卫生—骨科学]