铰链式外固定架治疗肘关节僵直的疗效观察

目的探讨应用铰链式外固定架治疗肘关节僵直的方法及疗效。方法将30例应用外固定架治疗的肘关节僵直患者归为治疗组,另随机选取30例单纯给予松解术治疗的肘关节僵直患者归为对照组。治疗组患者首先给予术前教育;术后3～14 d,应用外固定架对其肘关节进行控制,白天控制其处于伸肘位,夜间则控制其处于屈肘位;术后2～4周,嘱患者主动运动肘关节,增加关节活动范围(ROM);术后5～8周,采用Thera-Band训练带(弹力治疗带)进行肌力增强练习,拆除外固定架后给予强化关节ROM及肌力训练。经过10周治疗后,分别采用肘关节屈伸ROM及Mayo肘关节功能评分表对2组患者疗效进行评定。结果2组患者肘关节屈伸ROM及Mayo评分均较治疗前有显著改善,差异具有统计学意义(P<0．05);进一步分析后还发现,治疗组及对照组患者治疗后肘关节屈伸ROM及Mayo评分间差异具有统计学意义(P<0．05),提示治疗组疗效优于对照组。结论采用铰链式外固定架治疗肘关节僵直具有显著疗效,手术前、后的系统康复干预也是促进关节功能恢复的关键因素。     

创伤后肘关节僵硬松解术后并发症的护理干预

目的探讨创伤后肘关节僵硬行关节松解和铰链式外固定支架植入术后并发症的防治措施和护理干预。方法对23例创伤后肘关节僵硬松解术后的患者做好疼痛护理、针道护理、消肿处理、感觉功能保护与锻炼、全程系统康复、功能锻炼等综合护理干预措施。结果23例患者术后随访6～12月，铰链外固定支架平均使用8周，肘关节总关节活动度（ROM）由术前（36．43°±10．5°）增加到术后（111．4°±14．6°），肘关节功能Mayo评分由术前平均62．3分提高至术后81．4分。结论综合护理干预措施可以有效降低急性复发性肘关节僵硬、神经损伤、异位骨化、针道感染、持久关节挛缩等并发症，提高肘关节松解和铰链式外固定支架植入术的手术效果，获得较好的肘关节活动度和功能康复。     

肘部高能量创伤术后应用带铰链外固定架在早期康复中的优越性

目的:探讨肘部高能量创伤术后应用带铰链外固定架在早期康复中的作用。方法:选择2000-10/2004-06华西医院骨科收治肘部高能量创伤、同时接受内、外固定的患者78例。患者均知情同意。男43例,女35例,肱骨髁上粉碎性骨折13例,肱骨髁上髁间粉碎性骨折21例,Monteggia’s骨折26例,尺骨鹰嘴粉碎性骨折9例,尺骨冠突骨折5例,桡骨小头粉碎性骨折4例;合并环状韧带损伤17例,尺侧副韧带损伤25例,桡侧副韧带损伤8例;开放性骨折17例,闭合骨折61例。分为外固定架组35例,石膏、支具组43例,两组年龄、性别等无统计学差异。外固定架组患者术后3d开始在外固定架保护下进行肘关节屈伸活动;石膏、支具组术后4～6周拆除石膏、支具后开始活动。随访时观察患者骨折愈合情况;两组患者肘关节活动度及Gassebaum评分分级结果。采用Gassebaum分级指标评价治疗后肘关节功能恢复效果,优,肘关节无症状,伸肘15°,屈肘130°;良:肘关节有主观不适症状,伸肘30°,屈肘120°;可:肘关节有轻微不适症状,伸肘40°,屈肘90°～120°;差:关节功能受限,伸肘40°,屈肘<90°。肘关节活动度=屈曲角度-伸直角度。结果:78例患者平均随访14个月,均进入结果分析。①患者骨折愈合情况:术后3～6个月X射线片证实骨折愈合,内固定物无松动断裂,外固定架组无钉道感染和螺钉松动、断裂发生。②两组患者肘关节活动度及Gassebaum评分分级结果:术后3和6个月,外固定架组在术后肘关节功能恢复上好于石膏、支具组[(96±18)°比(55±14)°,(105±16)°比(74±21)°,t=10.835～7.386,P<0.05],外固定架组优良率为88.6%,石膏、支具组为58.1%。结论:①肘部高能量创伤以后,介入功能康复训练时间越早,越有利于肘关节活动度的恢复。②应用铰链外固定架在肘部高能量创伤术后对患者早期肘关节功能恢复比石膏、支具更有优越性。     

铰链式外固定共治疗肘关节僵直的疗效观察

目的探讨应用铰链式外固定架治疗肘关节僵直的方法及疗效。方法将30例应用外固定架治疗的肘关节僵直患者归为治疗组，另随机选取30例单纯给予松解术治疗的肘关节僵直患者归为对照组。治疗组患者首先给予术前教育；术后3-14d，应用外固定架对其肘关节进行控制，白天控制其处于伸肘位，夜间则控制其处于屈肘位；术后2-4周，嘱患者主动运动肘关节，增加关节活动范围（ROM）；术后5-8周，采用Tera-Band训练带（弹力治疗带）进行肌力增强练习，拆除外固定架后给予强化关节ROM及肌力训练，经过10周治疗后，分别采用肘关节屈伸ROM及Mayo肘关节功能评分表对2组患者疗效进行评定。结果2组患者肘关节屈伸ROM及Mayo评分均较治疗前有显著改善，差异具有统计学意义（P〈0.05），进一步分析后还发现，治疗组及对照组患者治疗后肘关节屈伸ROM及Mayo评分间差异具有显著疗效，手术前，后的系统康复干预也是促进关节功能恢复的关键因素。     

动态铰链式外固定架肘部松解术后专项康复训练对预防关节僵直的效果观察

目的探讨动态铰链式外固定架肘部松解术后患者的专项康复训练对预防关节僵直的效果。方法对我院动态铰链式外固定架肘部松解术后患者的康复训练进行回顾分析,选取2014年的42例患者为观察组,实施专项康复训练护理干预;选取2013年的42例患者为对照组,采取常规康复训练护理。术后3~6个月内对患者进行随访,采用肘关节活动度(ROM)及Mayo肘关节功能评分表进行评定对比。结果观察组42例患者中39例平均4.57个月随访,MEPS平均84.4分。ROM平均为110°,其中优33例,良5例,差1例。对照组仅36例平均4.23个月随访,MEPS平均74.4分,ROM平均96°,其中优27例,良6例,差3例。两组比较差异具有统计学意义(P0.01)。结论动态铰链式外固定架肘部松解术后患者的系统性、阶段性、有针对性的专项康复训练对预防关节僵直效果显著,值得临床推广使用。     

手术松解联合单臂铰链式外固定架治疗创伤后肘关节僵硬探讨

目的探讨手术松解联合单臂铰链式外固定架治疗对创伤后肘关节僵硬的改善作用。方法选取2013年1月—2018年1月就诊120例创伤后肘关节僵硬患者进行研究,按照随机数字表法进行分组,对照组行单纯松解术治疗,观察组(n=60)行手术松解联合单臂铰链式外固定架治疗,比较2组的手术效果。结果治疗前,2组肘关节功能评分(Mayo)、肘关节活动度差异无统计学意义(P 0. 05);治疗后,观察组均明显优于对照组(P 0. 05),且观察组患者肘关节优良率明显高于对照组(P 0. 05)。结论采用手术松解联合单臂铰链式外固定架方式对肘关节僵硬患者实施治疗可显著改善患者肘关节功能及活动度。     

肘关节创伤术后围手术期系统康复的临床研究

目的:前瞻性地研究严重肘关节创伤患者,术后围手术期系统康复治疗。方法:选择2002年8月—2003年5月间在我院创伤骨科住院治疗的肘关节创伤患者26例为研究对象,所有入选病例均为肘部关节内骨折的患者;并于伤后7—10天实施骨折切开复位内固定手术治疗。术后第1—5天开始康复治疗;随机选择对照组30例(术后自行锻炼)。结果:治疗组患者术后康复治疗时间为4—16周、平均(8.2±4.6)周;治疗结束时患者肘关节活动范围均达到正常,Mayo肘关节评分,20例为优(总分≥90分),6例为良(总分80—89分),优良率为100%。GEPI评分:2%—10%、平均5.9%±1.9%;无一例出现内固定物松动、骨折不愈合、废用性骨质疏松的征象。结论:肘关节严重创伤术后实行围手术期、个性化、系统性康复治疗,能够促进骨折愈合、伤肢功能障碍降低到最低的程度,从而提高了严重创伤患者的生活质量,康复治疗是骨关节损伤治疗过程中必不可少的重要环节。     

中药熨烫在铰链式外固定架治疗肘关节僵硬术后的应用观察

[目的]探讨中药熨烫在铰链式外固定架治疗肘关节僵硬术后的应用观察与护理。[方法]选取肘关节僵硬病人31例,随机分为治疗组(16例)与对照组(15例),分别进行开放性松解结合铰链式外固定支架固定术,对照组术后进行功能锻炼康复、一般护理等治疗与护理,治疗组在对照组功能锻炼康复基础上加用中药熨烫疗法。治疗及护理后根据肘关节活动范围(ROM)和Mayo肘关节功能评分进行比较。[结果]31例病人术后均获随访,治疗前两组肘关节ROM差异无统计学意义(P0.05),经过手术、康复治疗后两组肘关节功能均有明显改善,且治疗组肘关节ROM与功能恢复优良率高于对照组(P0.05)。[结论]铰链式外固定架治疗肘关节僵硬术后康复过程中应用中药熨烫治疗与护理疗效满意。     

创伤性膝关节僵硬患者粘连松解术后的康复护理

目的 加强创伤性膝关节粘连松解围手术科学的康复护理,增加肌力及加大关节活动度锻炼, 防止术中松解后关节活动度再度丢失,以获得最佳治疗效果。方法 通过手术松解膝关节周围粘连组织,围手术期运用心理护理、CPM锻炼、主被动功能锻炼、止痛等手段指导患者进行科学的功能康复。结果 术前膝关节活动度为10～60°,平均38±8.2°,术后随访时活动度为89~135°,平均112±5.4°,手术前后增加74°。所有患者术后无伤口坏死、骨折等并发症。结论 科学而系统的康复护理,在创伤性膝关节僵硬患者粘连松解围手术期具有重要意义,在护理过程中应给予高度重视。     

单臂铰链式外固定架辅助固定治疗复杂肘关节骨折脱位20例分析

目的 探讨单臂铰链式外固定架在复杂肘关节骨折脱位的应用和疗效.方法 2007-03-2010-07对20例复杂肘关节骨折脱位采用Orthofix单臂铰链式外固定架治疗.结果 采用Mayo评分:平均80分(60～95),肘关节平均活动度(100±20)°,前臂旋转平均(95±15)°.优8例,良8例,中4例.结论 铰链式外固定架的正确使用可明显降低复杂肘部损伤的致残率.     

关节镜下关节外操作治疗顽固性网球肘*

目的探究关节镜下关节外操作治疗顽固性网球肘的临床疗效。方法 2015年9月-2017年11月连续收治顽固性网球肘患者21例(21例肘)。其中,男8例,女13例,手术时患者年龄33~62岁,平均43岁;保守治疗时间为7~41个月,平均15.0个月。21例顽固性网球肘均采用关节镜下关节外操作手术治疗。结果 21例患者均获随访,随访时间6~26个月,平均17.3个月,无感染和神经损伤等严重并发症。21例在视觉模拟评分(VAS)、Mayo肘关节功能评分(MEPS)及外上髁压痛点压痛程度等方面术前术后有明显差异;19例对治疗结果非常满意,2例对治疗结果满意,无不满意病例。结论关节镜下关节外操作治疗顽固性网球肘,手术方式直观、安全,临床效果满意。     

针刺肘穴治疗网球肘康复评价及机理探讨

目的：观察针刺新穴“肘穴”医治网球肘的疗效,探讨其作用机理。方法：对确诊的患者采用单一针刺“肘穴”治疗,并对压痛度、自发性痛、 Ｒ Ｏ Ｍ（ 关节活动范围） 、 Ａ Ｄ Ｌ（ 日常生活能力） 进行每１ 疗次后的康复评定。结果：痊愈率达７３ ．２ ％ ,显著好转达１４．３％ ,无效仅１ ．８ ％ ,总有效率９８ ．２ ％ 。其中第１ 次疗后４ 项评分均有明显提高, Ｐ＜ ０ ．００１。结论： 第１“肘穴”系既往文中无记载的新穴,针刺该穴具有医治网球肘的良好效果,值得推广应用。第２ 针刺该穴的机理可能与“生物全息律”、脊髓交互抑制等有关。     

Sonographic Evaluation of the Distal Biceps Tendon Using a Medial Approach

Objective. The purpose of this report is to describe and demonstrate the potential advantages of a technique to image the distal biceps tendon using a medial approach: the pronator window. Methods. Distal biceps tendon imaging via the medial approach was shown using real‐time sonography on an asymptomatic volunteer as well as cadaveric anatomic dissection. Results. The medial approach images the biceps tendon with minimal anisotropy while providing several potential advantages, including (1) complete visualization of the ulnarly facing radial tuberosity and the tapered distal biceps insertion, (2) increased contrast and reduced beam attenuation at the interface between the biceps tendon and overlying brachial artery, and (3) avoidance of the beam‐attenuating effects of the supinator encountered when imaging the tendon from a lateral approach. Conclusions. The medial approach to image the distal biceps tendon complements previously described techniques and should be considered in the evaluation of patients presenting with distal biceps tendon disorders. Future clinical studies may elucidate the relative advantages and disadvantages of sonographic distal biceps imaging techniques in specific patient populations.     

Sonographically guided percutaneous needle tenotomy for treatment of common extensor tendinosis in the elbow.

OBJECTIVE: Chronic tendinosis of the common extensor tendon of the lateral elbow can be a difficult problem to treat. We report our experience with sonographically guided percutaneous needle tenotomy to relieve pain and improve function in patients with this condition. METHODS: We performed sonographically guided percutaneous needle tenotomy on 58 consecutive patients who had persistent pain and disability resulting from common extensor tendinosis. Under a local anesthetic and sonographic guidance, a needle was advanced into the common extensor tendon, and the tip of the needle was used to repeatedly fenestrate the tendinotic tissue. Calcifications, if present, were mechanically fragmented, and the adjacent bony surface of the apex and face of the epicondyle were abraded. Finally, the fenestrated tendon was infiltrated with a solution containing corticosteroid mixed with bupivacaine. After the procedure, patients were instructed to perform passive stretches and to undergo physical therapy. During a subsequent telephone interview, patients answered questions about their experience, their functioning level, and their perceptions of procedure outcome. RESULTS: Fifty-five (95%) of 58 patients were contacted by telephone and agreed to participate in the study. Thirty-five (63.6%) of 55 respondents reported excellent outcomes, 16.4% good, 7.3% fair, and 12.7% poor. The average follow-up time from the date of the procedure to the date of the interview was 28 months (range, 17-44 months). No adverse events were reported; 85.5% stated that they would refer a friend or close relative for the procedure. CONCLUSIONS: Sonographically guided percutaneous needle tenotomy for lateral elbow tendinosis is a safe, effective, and viable alternative for patients in whom all other nonsurgical treatments failed.     

Sonographically Guided Percutaneous Needle Tenotomy for Treatment of Common Extensor Tendinosis in the Elbow

Objective. Chronic refractory common extensor tendinosis of the lateral elbow has been shown to respond to sonographically guided percutaneous needle tenotomy (PNT) followed by corticosteroid injection. In this analysis, we attempted to determine whether the corticosteroid is a necessary component of the procedure. Methods. We performed PNT on 57 consecutive patients (age range, 34–61 years) with persistent pain and disability resulting from common extensor tendinosis. Under a local anesthetic and sonographic guidance, a needle was advanced into the tendon, and the tip of the needle was used to fenestrate the tendinotic tissue, break up any calcifications, and abrade the adjacent bone. After the procedure, patients underwent a specified physical therapy protocol. During a subsequent telephone interview, patients answered questions about their symptoms, the level of functioning, and perceptions of the procedure outcome. Results. Of the 52 patients who agreed to participate in the study, 30 (57.7%) reported excellent outcomes, 18 (34.6%) good, 1 (1.9%) fair, and 3 (5.8%) poor. The average follow‐up time from the date of the procedure to the telephone interview was 22 months (range, 7–38 months). No adverse events were reported, and 90% stated that they would refer a friend or close relative for the procedure. Conclusions. Sonographically guided PNT for refractory lateral elbow tendinosis is an effective procedure, and subsequent corticosteroid injection is not necessary.     

小儿肘部静脉穿刺留置针在药物输注中的应用

临床护理工作中，由于肘部静脉位于肘关节附近，血管暴露不明显，加上小儿操作固定上的不配合，因此，很少有人选择小儿肘部静脉穿刺作为静脉用药的途径，但在儿科静脉输注中，经常遇到一些刺激性强的药物，如甘露醇、更昔洛韦、促肾上腺皮质激素、静脉营养液等，这些药物经外周静脉输注易引起静脉炎，另外长期输液患儿外周静脉及其他部位血管反复穿刺而导致患儿静脉穿刺困难。此外，少数肥胖的患儿外周静脉暴露差也造成静脉穿刺困难。     

Sonography of Benign Palpable Masses of the Elbow

The purpose of this pictorial essay is to show the sonographic appearances of benign masses found in and around the elbow, including fat‐containing tumors, fibrous tumors, vascular lesions, selected skin lesions, and other miscellaneous lesions. Sonographic features, including the use of dynamic and color Doppler imaging, can be helpful in characterizing these masses and in narrowing the differential diagnosis.     

采用超声检查评估儿童肘部损伤价值的探讨

目的评价儿童肘部超声检查的价值.方法对不同年龄阶段儿童正常肘部进行超声检查,观测声像图结构及其动态变化.结果超声检查可以反映儿童肘部解剖结构的情况,对骨性表面结构、软骨性结构及软组织结构都能够进行了解.结论儿童肘部超声检查是一种简便、灵活、经济的影像学检查.     

Effects of Hypertonic Dextrose Injection (Prolotherapy) in Lateral Elbow Tendinosis: A Systematic Review and Meta-analysis

ObjectiveTo systematically review the effectiveness of hypertonic dextrose prolotherapy (DPT) on pain intensity and physical functioning in patients with lateral elbow tendinosis (LET) compared with other active non-surgical treatments.Data SourcesSystematic search of Cochrane Central Register of Controlled Trials, MEDLINE, EMBASE, Web of Science, PubMed, Dimensions, Global Health, NHS Health Technology Assessment, Allied and Complementary Medicine, and OVID nursing database from inception to June 15, 2021, without language restrictions.Study SelectionTwo reviewers independently identified parallel or crossover randomized controlled trials that evaluated the effectiveness of DPT in LET. The search identified 245 records; data from 8 studies (354 patients) were included.Data ExtractionTwo reviewers independently extracted data and assessed included studies. The Cochrane Risk of Bias 2 tool was used to evaluate risk of bias. The Grading of Recommendation Assessment, Development, and Evaluation approach was used to assess quality of the evidence.Data SynthesisPooled results favored the use of DPT in reducing tennis elbow pain intensity compared with active controls at 12 weeks postenrollment, with a standardized mean difference of ?0.44 (95% confidence interval, ?0.88 to ?0.01, P=.04) and of moderate heterogeneity (I²=49%). Pooled results also favored the use of DPT on physical functioning compared with active controls at 12 weeks, with Disabilities of the Arm, Shoulder and Hand scores achieving a mean difference of ?15.04 (95% confidence interval, ?20.25 to ?9.82, P<.001) and of low heterogeneity (I²=0.0%). No major related adverse events have been reported.ConclusionsDPT is superior to active controls at 12 weeks for decreasing pain intensity and functioning by margins that meet criteria for clinical relevance in the treatment of LET. Although existing studies are too small to assess rare adverse events, for patients with LET, especially those refractory to first-line treatments, DPT can be considered a nonsurgical treatment option in carefully selected patients. Further high-quality trials with comparison with other injection therapies are needed.