摘要目的 评估并比较采用侧方与后正中入路松解僵直肘的临床效果.方法 对44例肘关节僵硬患者采用手术松解.其中22例取肘侧方入路,经内侧入路分离关节囊后壁并清理肘后侧鹰嘴窝,经外侧入路分离关节囊前壁及清理桡骨头.22例取肘后正中皮肤切口,完整分离肱三头肌以清理鹰嘴窝,两侧深层显露采用侧方肌间隙入路.结果 44例获得14～52个月(平均23.2个月)的随访.侧方人路:术后肘关节活动度平均为[(108.0±12.4)°,-/x±s,下同],术后Mayo肘关节功能评分平均为(83.4±2.4)分.后正中人路:术后肘关节活动度平均为(95.7±17.3)°,术后Mayo肘关节功能评分平均为(79.2±6.9)分.两组松解疗效差异均较术前有统计学意义(P<0.01),组间术后平均活动度差异有统计学意义(P<0.05),组间术后平均Mayo肘关节功能评分差异有统计学意义(P<0.05).结论 采用侧方或后正中入路的松解方法 ,对僵直肘安全有效.肘侧方入路松解可获得比后正中人路松解更好的临床效果.

abstractsObjective To evaluate and compare the clinical outcomes of stiff elbow release via combined lateral and medial approach and via posterior median approach. Methods Arthrolysis was performed in 44 cases with stiff elbow. Combination of lateral and medial approach was carried out in 22 cases. The posterior capsule was excised and the olecranon fossa was debrided through the medial approach. The anterior capsule was excised and the radial head was debfided through the lateral approach. The posterior median approach was carried out in the other 22 cases. The olecranon fossa was debridod after detachment of triceps insertion. Exposure of the deep structures on both sides of the joint was achieved by dissection via intermuscular septums. Results All patients were followed up for a mean 23.2 months (ranged from 14 to 52 months). The mean range of motion of the elbow joint in patients treated with combined lateral and medial approach was (108.0±12.4)°, while the mean Mayo Elbow Score was (83.4±2.4). The mean range of motion in patients with posterior median approach was (95.7±17.3)°, while the mean Mayo Elbow Score was (79.2±6.9). The clinical results of the two groups were statistically different (P<0.01). Range of motion and the Mayo Elbow Score between the two groups showed statistically significant differences (P<0.05). Conclusion Surgical release of stiff elbow via combined lateral and medial approach and via posterior median approach is safe and effective. Combined lateral and medial approach leads to better clinical outcomes than the posterior median approach.