手术清理联合活动外固定架治疗肘关节创伤后异位骨化的疗效分析

目的:评价内外侧联合入路手术清理联合活动外固定架对创伤后异位骨化(heterotopic ossification,HO)合并肘关节僵硬患者的临床疗效。方法:2010年7月至2013年12月,采用肘关节内外侧联合入路松解结合活动外固定架固定治疗HO合并肘关节僵硬患者26例,其中男18例,女8例;年龄14~60岁,平均37.7岁;手术松解距受伤时间7~18个月,平均9.3个月。测量患者术前、术后的肘关节屈伸、前臂旋转角度,并进行Mayo评分。结果:1例术后3周出现外固定架针孔慢性感染,给予去除外固定架,余所有患者伤口Ⅰ期甲级愈合。26例均获随访,时间24~40个月,平均34个月。1例术后8个月出现2次HO。术后2年所有患者肘关节屈伸活动度、旋转活动度及Mayo评分较术前有明显改善(P0.05)。结论:采用肘关节内外侧联合入路松解结合活动外固定架固定治疗创伤后HO合并肘关节僵硬可有效改善肘关节功能,疗效满意。

Analysis on the effect of surgical cleaning combined with external fixator for the treatment of post-traumatic heterotopic ossification of elbow joint

Objective: To evaluate the clinical efficacy of surgical treatment using a combined medial and lateral approach combined with an external fixator for the treatment of post-traumatic heterotopic ossification (HO) in patients with stiff elbow joints.Methods: Surgical release using the combined medial and lateral approach combined with external fixation for the treatment of HO and elbow stiffness in 26 patients from July 2010 to December 2013.The study group included 18 males and 8 females, with an average age 38.7 years (ranged 14 to 60 years).The time from injury to surgery averaged 9.3(ranged 7 to 18) months.Before and after operation, the elbow range of motion and forearm rotation angle were measured, and the Mayo Elbow Performance Score (MEPS) was evaluated.Results: The wound of all patients was well healed during the first period, except one patient who had chronic infection at the external fixation pin 3 weeks after operation.Then the external fixator was removed.All 26 patients were followed up, and the during ranged from 24 to 40 months, with an average of 34 months.HO recurrence occurred in 1 patient 8 months after operation.The range of motion, forearm rotation angle, and Mayo Elbow Performance Score of elbow joint in patients was significantly improved compared with that before surgery (P<0.05).Conclusion: Surgical release using the combined medial and lateral approach combined with an external fixator for the treatment of traumatic HO and elbow stiffness can effectively improve elbow function, resulting in a satisfactory effect.