肘关节僵硬开放松解术后尺神经炎发生的影响因素分析  

Analysis of risk factors of ulnar neuritis after open arthrolysis in patients with elbow stiffness

作　　者：张晶晶 孙志坚 谭杰 王宇章 余翔 公茂琪 ZHANG Jingjing;SUN Zhijian;TAN Jie;WANG Yuzhang;YU Xiang;GONG Maoqi(Department of Orthopaedics,Taiyuan Xishan Hospital,Taiyuan 030053;Department of Orthopaedic Trauma,Beijing Jishuitan Hospital,Capital Medical University,Beijing 100035;Department of Rehabilitation Medicine,Beijing Jishuitan Hospital,Capital Medical University,Beijing 100035,China)

机构地区：[1]太原西山医院骨科,太原030053 [2]首都医科大学附属北京积水潭医院创伤骨科,北京100035 [3]首都医科大学附属北京积水潭医院康复医学科,北京100035

出　　处：《中华骨与关节外科杂志》2024年第1期50-57,共8页Chinese Journal of Bone and Joint Surgery

摘　　要：目的:探讨肘关节僵硬开放松解术后出现尺神经炎的影响因素。方法:对2020年4月至2021年6月间因肘关节僵硬行开放松解术的96例患者的术后最大屈曲改善角度、最大伸直改善角度及术后尺神经炎发生及转归情况进行随访。结果:根据纳入与排除标准,共纳入男59例,女37例,年龄14~62岁,平均(37.3±10.7)岁。术后出现尺神经炎症状患者29例,其中McGowanⅠ型28例,McGowanⅡ型1例。随访时间12~25个月,平均(17.1±4.0)个月,27例患者症状完全缓解。二分类logistic回归分析结果表明,患者性别、原始损伤类型、术后最大屈曲改善角度是肘关节僵硬松解术后尺神经炎发生的主要风险因素。女性患者术后出现尺神经炎并发症的风险是男性患者的3.712倍(OR=3.712,95%CI:1.592~8.653);原始损伤类型为肘关节周围骨折或脱位的患者,术后出现尺神经炎并发症的风险是肘关节外骨折或非骨折患者的4.552倍(OR=4.552,95%CI:1.053~19.681);术后屈曲改善度在60°及以上的患者,术后出现尺神经炎的风险是术后屈曲改善度在30°及以下患者的14.184倍(OR=14.184,90%CI:2.199~91.478)。结论:肘关节僵硬松解术后尺神经炎发生率较高,既往患有肘关节周围骨折或脱位、女性患者、术后最大屈曲改善角度60°及以上是术后出现尺神经炎的主要风险因素。Objective:To investigate the risk factors of ulnar neuritis after open arthrolysis in patients with elbow stiffness.Methods:A retrospective study was conducted on 96 patients who underwent open arthrolysis for elbow stiffness from April 2020 to June 2021.The study involved assessing postoperative maximal improvement in flexion arc,the maximal improvement in extension arc,and the occurrence and outcome of ulnar neuritis.Results:According to the inclusion and exclusion criteria,59 males and 37 females aged 14 to 62 years were enrolled,with an average age of(37.3±10.7)years.A total of 29 patients developed ulnar neuritis after the operation,including 28 patients with McGowan typeⅠand 1 patient with McGowan typeⅡ.The follow-up period ranged from 12 to 25 months,with a mean of(17.1±4.0)months,symptoms were completely resolved in 27 patients.Binary logistic regression analysis showed that gender,original injury type and postoperative maximal improved flexion arc were the main risk factors for ulnar neuritis after open arthrolysis for elbow stiffness.The risk of postoperative ulnar neuritis in females was 3.712 times that of males(OR=3.712,95%CI:1.592-8.653);the risk of postoperative ulnar neuritis in patients with peri-elbow fracture or dislocation was 4.552 times that of patients with an extra-elbow fracture or non-fracture(OR=4.552,95%CI:1.053-19.681);the risk of ulnar neuritis in patients with postoperative improved flexion arc more than 60°was 14.184 times that of patients with postoperative improved flexion arc less than 30°(OR=14.184,95%CI:2.199-91.478).Conclusions:The incidence of postoperative ulnar neuritis is relatively high after open arthrolysis for elbow stiffness.The main risk factors for postoperative ulnar neuritis include a history of peri-elbow fracture or dislocation,female,or a postoperative maximal improved flexion arc of 60°or more.

关 键 词：肘关节僵硬 开放松解术 尺神经炎 风险因素 

分 类 号：R683.4[医药卫生—骨科学]