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肘关节松解术治疗创伤后肘关节僵硬:附258例报告

Arthrolysis for 258 cases of post-traumatic elbow stiffmess

摘要:

目的 探讨肘关节松解术治疗创伤后肘关节僵硬的疗效及并发症. 方法 2007年4月至2011年4月共收治306例肘关节僵硬患者,其中258例获得完整随访,男166例,女92例;年龄16~70岁,平均36.7岁.左侧142例,右侧116例;主力侧119例,非主力侧139例.对符合术前肘关节间隙正常、异位骨化轻微及术中未进行主要侧副韧带起止点剥离3个条件者行单纯肘关节松解术,其余患者均行肘关节松解结合铰链式外固定支架固定.分别采用内侧、外侧、后方正中或内外侧联合4种入路. 结果 258例患者术后获6 ~48个月(平均12.0个月)随访.213例患者松解术后使用外固定支架保护,外固定支架平均使用时间为7.7周(5~11周),其余45例患者仅单纯进行松解.屈伸活动度:术前平均为42.4°±31.1°(0~90°),术后平均为96.2°±18.2°(60° ~ 140°),改善53.9°±36.0°(0~140°);旋转活动度:术前平均为136.8°±49.1° (10°~ 180°),术后平均为161.2°±22.2° (120° ~180°),改善24.4°±33.4°(0 ~ 110°);Mayo肘关节功能评分:术前平均为(71.5±15.3)分(60 ~ 100分),术后平均为(91.6±7.3)分(85~ 100分),改善(20.0±17.1)分(0~40分),以上项目术前、术后比较差异均有统计学意义(P<0.05).95例患者在松解术后出现肘后血肿、伤口裂开、针道感染、外固定支架断裂及神经损伤等并发症.结论 术前良好评估、严格掌握适应证,肘关节松解术效果良好.完善治疗细节可减少多种并发症的发生.

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abstracts:

Objective To analyze functional recovery and complications in patients undergoing arthrolysis for post-traumatic elbow stiffness. Methods From April 2007 to April 2011,306 cases of stiff elbow were treated by the same treating team.Of them,258,166 men and 92 women,were fully followed up.Their average age was 36.7 years old.The stiff elbow was on the left in 142 cases,on the right in 116 cases,on the dominant side in 119 cases and on the nondominant side in 139 cases.They were treated with sole arthrolysis or arthrolysis combined with hinged external fixators according to specific conditions.Based on the original approaches used and specific causes of elbow stiffness we adopted the medial,lateral,posterior or medial combined with lateral approaches. Results The average follow-up time was 12.0 months (from 6 to 48 months).Arthrolysis combined with hinged external fixators was performed in 213 cases,with a mean time of external fixation of 7.7 weeks (from 5 to 11 weeks).Sole arthrolysis was performed in the other 45 cases.The mean range of motion (ROM) in extension and flexion was improved by 53.9° ± 36.0° (0° to140°),from preoperative 42.4° ± 31.1 ° (0° to 90°) to peostoperative 96.2° ± 18.2° (60° to 140°) ; the mean pronation and supination was improved by 24.4° ± 33.4° (0° to 110°),from preoperative 136.8 ± 49.1 ° ( 10° to 180°) to postoperative 161.2°± 22.2° (120° to 180°).The mean Mayo Elbow Performance Score (MEPS) was improved by 20.0 ± 17.1 points (0 to 40 points),from preoperative 71.5 ± 15.3 points (60 to 100 points) to postoperative 91.6 ± 7.3 points (85 to 100 points). There were significant differences between preoperation and postoperation in all the indexes above ( P < 0.05).Hematoma at the posterior elbow,wound dehiscence,pin hole infection,external fixator breakage and nerve lesions were observed in 95 patients postoperatively. Conclusions As long as preoperative appraisal of the condition is precise and operative indications are strictly followed,arthrolysis can achieve satisfactory outcomes in management of post-traumatic elbow stiffness.Meticulous operative protocols can reduce postoperative complications.

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