间隔式肘关节成形术治疗中青年创伤后肘关节僵硬并肘关节炎远期疗效观察  

Long-term effect of interval elbow arthroplasty in the treatment of traumatic elbow stiffness complicated with elbow arthritis in middle-aged and young people

作　　者：张永祥 杨颇 罗明辉 徐浩然 郭勇 何立民 吴启弘 潘杰 ZHANG Yong-xiang;YANG Po;LUO Ming-hui;XU Hao-ran;GUO Yong;HE Li-min;WU Qi-hong;PAN Jie(Department of Traumatic Orthopedics,the Second Affiliated Hospital of Guizhou University of Traditional Chinese Medicine,Guiyang,Guizhou,550000,China)

机构地区：[1]贵州中医药大学第二附属医院创伤骨科,贵阳550000

出　　处：《中国骨与关节杂志》2024年第12期978-982,共5页Chinese Journal of Bone and Joint

基　　金：贵州省卫生健康委科学技术发展项目(gzwkj2022-086);中国康复医学会科技发展项目(KFKT-2023-023)。

摘　　要：目的探讨间隔式肘关节成形术治疗中青年患者创伤性肘关节僵硬(traumatic elbow stiffness,TES)合并肘关节炎的临床疗效。方法回顾分析2013年3月至2021年6月我院收治的11例TES并肘关节炎患者临床资料,其中男7例,女4例;年龄18~47岁,平均(37.46±8.80)岁。创伤原因:肱骨远端骨折4例、陈旧性肘关节脱位2例、髁间骨折2例、鹰嘴骨折2例、桡骨头骨折1例,病程6个月至20年;其中桡骨头骨折术后僵硬患者入院后先行内固定取出术,再行间隔式肘关节成形术治疗,其余患者均一期手术治疗。比较患者术前、术后末次随访时肘关节活动度(range of motion,ROM)、肘关节疼痛视觉模拟评分(visual analogue scale,VAS)、Mayo肘关节功能评分(Mayo elbow-performance score,MEPS)及Barthel指数评定量表。结果11例患者均顺利完成手术并获得随访,平均随访88.27(43~130)个月。末次随访时,ROM由术前(45.45±17.40)°提高至(105.55±15.59)°,VAS疼痛评分由术前(7.45±1.21)分降低至(2.55±1.13)分,MEPS评分由术前(41.36±8.39)分提高至(79.09±5.39)分,Barthel指数由术前(78.64±5.05)分提高至(92.27±4.67)分,差异有统计学意义(P<0.05)。所有患者术后随访期间均未发生神经血管损伤、关节失稳、再发僵硬等并发症。结论间隔式肘关节成形术治疗中青年患者TES合并肘关节炎能够有效改善患者肘关节功能及减轻疼痛,远期疗效满意,可作为无肘关节置换意愿的TES并肘关节炎患者的一种替代性治疗手段。Objective To investigate the clinical effect of interval elbow arthroplasty in the treatment of traumatic elbow ankylosis complicated with elbow arthritis.Methods The clinical data of 11 patients with traumatic elbow ankylosis treated in our hospital from March 2013 to June 2021 were analyzed retrospectively,including 7 males and 4 females,aged from 18 to 47,with an average of(37.46±8.80)years.The causes of trauma included distal humeral fracture(n=4),old elbow dislocation(n=2),intercondylar fracture(n=2),olecranon fracture(n=2)and radial head fracture(n=1),ranging from 6 months to 20 years.The elbow joint activity(range of motion,ROM),visual analogue score of elbow pain(visual analogue scale,VAS),Mayo elbow function score(Mayo elbow-performance score,MEPS)and Barthel index rating scale were compared before and after the last follow-up.Results All the 11 patients completed the operation successfully and were followed up for an average of 88.27(43-130)months.At the last follow-up,the ROM of elbow joint increased from(45.46±17.40)°to(105.55±15.59)°;VAS pain score decreased from(7.45±1.21)to(2.55±1.13);MEPS score increased from(41.36±8.39)to(79.09±5.39);Barthel index increased from(78.64±5.05)to(92.27±4.67),and the differences were statistically significant(P<0.05).No complications such as neurovascular injury,joint instability and recurrent stiffness occurred during the follow-up period.Conclusions Interval elbow arthroplasty can effectively improve the function of the elbow joint and relieve pain in the treatment of traumatic elbow stiffness with elbow arthritis in young and middle-aged patients, and the long-term effect is satisfactory. It can be used as an alternative treatment fortraumatic elbow stiffness with elbow arthritis for patients without the willingness of elbow replacement.

关 键 词：肘关节 关节成形术 关节炎 移植 自体 

分 类 号：R684.3[医药卫生—骨科学]