肘关节镜微创治疗肘关节屈伸功能障碍

目的探讨肘关节镜微创治疗肘关节屈伸功能障碍的适应证、手术方法及术后康复锻炼。方法对自2008年11月~2011年8月收治的29例肘关节屈伸活动功能障碍均行肘关节镜下松解清理术,术后按统一标准化方案行康复功能训练,对比术前、术后肘关节屈伸活动度,采用Mayo肘关节功能评分进行比较。结果患者术后获随访8~16个月,平均11.3个月,21例肘关节屈伸活动功能均有很大程度的改善。术前平均主动伸直活动度为(38±24)°,屈曲活动度为(102±19)°。术后平均主动伸直活动度为(10±7)°,屈曲活动度为(118±15)°,术前、术后伸直活动度改善(27.8±10.4)°,术前、术后屈曲活动度增加(16.4±3.3)°,术前及术后屈、伸活动度差异有统计学意义(P<0.05)。采用Mayo肘关节功能评分进行比较,术前良8例,中15例,差6例;术后优8例,良14例,中5例,差2例。结论肘关节镜微创治疗肘关节屈伸功能障碍具有创伤小、康复快、是一种有效治疗肘关节屈伸功能障碍的方法。     

关节镜治疗踝关节剥脱性骨软骨炎

目的 探讨踝关节镜下关节清理加微骨折术治疗踝关节剥脱性骨软骨炎的手术效果.方法 对11例踝关节剥脱性骨软骨炎,采用关节清理加微骨折钻孔,通过随访了解患侧踝关节疼痛、肿胀及活动度的改善情况.结果 所有患者均获得随访,平均随访时间11.5个月,术前VAS评分平均为(70.6±3.4)分,术后随访时VAS评分为(17.9±4.6)分,两者差异有统计学意义(P＜0.01);术前AOFAS踝关节功能主观评分平均为(64.3±4.7)分,术后随访时为(87.4±3.2)分,两者差异有统计学意义(P＜0.05).术后1例出现切口皮肤麻木感.结论 关节镜下清理加微骨折术治疗踝关节剥脱性骨软骨炎,具有创伤小、患者症状明显改善及手术并发症少的优点,是一种微创、有效的方法.     

尺骨截骨矫形关节囊松解紧缩治疗儿童陈旧性孟氏骨折

目的 :探讨儿童陈旧性孟氏骨折的手术治疗经验及治疗效果。方法 :自2013年1月至2017年12月治疗32例陈旧性孟氏骨折,男18例,女14例;年龄2~9(5.3±1.2)岁;均无桡神经损伤症状。患者术前症状为肘关节疼痛、畸形,屈伸及前臂旋转受限,X线示尺骨畸形愈合或呈"弓形征",桡骨头脱位或半脱位。术中作尺骨脊后方切口,在尺骨成角畸形最明显处行额状面长斜形截骨,然后采用Boyd切口显露肱桡关节及上尺桡关节,清理关节内的瘢痕组织,复位桡骨头,并在维持肘关节稳定的前提下,对尺骨截骨处进行处理,予钢板螺钉内固定。结果:32例患儿均随访,时间12~24个月,平均14.8个月,其中1例患儿出现术口感染。根据Mackay评定标准:32例患儿术后均无肘、腕关节疼痛症状,29例患儿肘关节屈伸活动度(130±5)°/0°,前臂旋前旋后活动度90°/(85±5)°;2例患儿肘关节屈伸活动度(119°/8°,121°/7°),前臂旋前旋后活动度(90°/75°,85°/60°);1例患者肘关节屈伸活动度90°/10°,前臂旋前旋后活动度80°/60°。优29例,良2例,中1例。结论:尺骨截骨矫形、肘关节后关节囊松解、前关节囊紧缩是治疗儿童陈旧性孟氏骨折的有效方法。     

肘关节剥脱性骨软骨炎关节镜治疗中期疗效

[目的]评价关节镜技术在肘关节剥脱性软骨炎诊断、治疗中的作用以及疗效。[方法]2011年5月~2014年7月,对17例患者施行肘关节镜检查、滑膜清理、游离体取出以及微骨折术,男11例,女6例;年龄15~35岁,左侧5例,右侧12例。17例均有肘关节疼痛,10例有肘关节卡压或绞锁等机械症状。患者取侧卧位全身麻醉下,经中外侧(软点)、近端前外侧、近端前内侧、后正中、后外侧等入路,行肘关节探查、清理、游离体取出以及微骨折术。分别测量术前术后肘关节伸直角度、屈曲角度、肘关节活动度,应用Mayo肘关节功能评分(Mayo elbow performance score,MEPS)评价疗效。[结果]术后患者伤口均I期愈合,无血管损伤并发症,17例获得10~48个月,平均28.5个月随访。术后15例(88.2%)肘疼痛消失或仅有轻微疼痛,2例(11.8%)肘仍有中等程度疼痛。10例有机械交锁症状者均消失。肘关节伸直角度、屈曲角度、肘关节活动度以及MEPS值均较术前明显改善(P0.05),术后MEPS结果优11例,良3例,中2例,优良率:88.2%。术后并发症:1例尺神经暂时性麻痹。[结论]肘关节镜治疗肘关节剥脱性软骨炎疗效确切,可以明显缓解肘关节疼痛,改善关节活动范围,损伤小、恢复快。     

肘关节镜结合小切口治疗肘关节骨关节炎合并肘尺管综合征疗效分析

目的 探讨19例肘关节骨关节炎合并肘尺管综合征患者应用肘关节镜结合小切口治疗的临床疗效。方法 2020年3月至2021年6月江苏省人民医院浦口分院骨科收治19例肘关节骨关节炎合并肘管综合征患者，其中男15例，女4例，年龄35～55岁，平均(41.80±4.90)岁。对其行肘关节镜手术并结合小切口行尺神经松解手术治疗，采用疼痛视觉模拟评分(visual analogue scale, VAS)、Mayo肘关节功能评分、肘关节活动度评价其临床效果。结果 患者均获随访，随访时间10～14个月，平均(11.80±1.30)个月，术后均未发生感染、切口愈合不良、神经血管损伤、异位骨化等并发症。19例患者肘关节屈伸活动度明显改善，疼痛明显减轻，10例患者小指及环指尺侧半感觉基本恢复正常，8例症状明显减轻，1例改善不明显，考虑尺神经卡压时间长、损伤严重所致。VAS评分从术前(5.89±1.33)分降为术后14个月(1.84±0.69)分，Mayo评分从(59.32±7.80)分改善为(80.05±7.20)分，关节活动度由术前(79.68±7.69)°增加为(115.84±10.99)°,术前与术后...     

肘关节挛缩患者肘关节镜术后的康复护理

目的 通过病例总结分析肘关节镜术后康复护理的综合临床疗效.方法自2006年3月至2009年3月间收治且获得随访的38例肘关节挛缩患者,男26例,女12例;平均47.8岁(26～66岁).采用关节镜手术进行肘关节松解,术后开始综合康复护理治疗.在术后3、6个月时分别记录肘关节的伸屈活动度、Mayo肘关节功能评分(MPES)、视觉模拟评分(VAS),并与术前相应指标进行比较.结果 本组患者随访6～12个月,平均8个月.肘关节的伸屈范围术前平均为65°±15°,MEPS评分为65±15,VAS评分为3±1;术后3个月伸屈平均为105°±15°,MPES评分为(90±20)分,VAS评分为(0.5±0.5)分;术后6个月伸屈平均为110°±10°,MPES评分为(94±18)分,VAS评分为(0.5±0.5)分.经手术及综合康复护理治疗后肘关节的伸屈活动度、MEPS评分和VAS评分较术前有明显改善,差异有统计学意义(P＜0.05),但术后3个月与术后6个月各项指标比较,差异无统计学意义(P＞0.05).结论 经过综合康复护理治疗,可以使接受肘关节镜手术的患者早期恢复良好的功能活动.     

关节镜治疗肘关节屈伸受限的临床研究

目的探讨关节镜下手术治疗肘关节屈伸活动受限的临床疗效。方法收集自2014年2月至2017年12月间,在我院接受关节镜手术治疗肘关节屈伸活动受限的患者28例,其中男21例,女7例;年龄18~72岁;左侧10例,右侧18例。创伤性骨关节炎19例,非创伤性骨关节炎9例。根据病因分为创伤组(19例)和非创伤组(9例)。术后常规康复训练,对比术前、术后肘关节屈伸活动度、Mayo评分、视觉模拟评分(visual analogue scale,VAS)的随访结果。结果术后随访26例,失访2例,平均随访18.8个月(6~28个月)。术前Mayo评分创伤组良9例,中6例,差3例;非创伤组良4例,中2例,差2例。术后Mayo评分创伤组优13例,良5例;非创伤组优6例,良2例。创伤组术前伸直活动度平均为(28.6±15.5)°,术后末次随访时平均为(6.1±4.1)°;屈曲活动度术前为(97.9±16.5)°,术后末次随访时平均为(138.7±7.2)°;疼痛VAS评分术前平均为(4.4±1.6)分,术后12个月平均为(1.1±0.6)分。非创伤组术前伸直活动度平均为(27.9±14.7)°,术后末次随访时平均为(5.7±3.8)°;屈曲活动度术前为(99.4±18.1)°,术后末次随访时平均为(136.7±7.7)°;疼痛VAS评分术前平均为(4.1±1.3)分,术后12个月平均为(1.3±0.7)分。结论无论是创伤后或是非创伤性患者,用关节镜治疗肘关节屈伸活动受限是一种有效和安全的选择,均可提高屈曲、伸展和肘关节功能评分,改善其功能。     

平行与垂直双钢板内固定治疗AO-C型肱骨远端骨折的疗效比较

目的比较平行双钢板及垂直双钢板内固定治疗AO-C型肱骨远端骨折的临床疗效。方法回顾性分析自2011-03—2016-01诊治的32例AO-C型肱骨远端骨折,采用平行双钢板内固定治疗17例(平行组),采用垂直双钢板内固定治疗15例(垂直组)。比较2组术后6个月VAS评分,末次随时肘关节活动屈伸范围、前臂旋转范围及肘关节功能Mayo评分,术后并发症发生情况。结果 32例均获得随访6~12个月,平均10.5个月。平行组1例出现尺神经损伤,予以甲钴胺片营养神经治疗4个月后神经症状恢复;垂直组1例出现轻度异位骨化,患肘屈伸约92°,旋转102°,活动明显受限;平行组、垂直组各2例出现肘关节活动明显受限,需二期行肘关节松解术。2组并发症比较差异无统计学意义(P0.05)。平行组术后6个月VAS评分为(0.59±0.71)分,垂直组为(0.60±0.63)分,2组差异无统计学意义(P0.05)。2组患侧肘关节屈伸活动度、前臂旋转活动度及肘关节功能Mayo评分比较差异均无统计学意义(P0.05)。结论垂直双钢板或平行双钢板内固定治疗AO-C型肱骨远端骨折均可取得良好疗效,应根据骨折的形态、软组织损伤程度、患者一般情况选择适当的内固定方式。     

肘关节镜下清理松解治疗肘关节骨关节炎并发强直的疗效分析

目的探讨肘关节镜下清理松解术治疗肘关节骨关节炎并发肘关节强直的疗效。方法2013年4月至2015年3月河南省洛阳正骨医院上肢损伤科共治疗并发肘关节强直的重度肘关节骨关节炎19例,平均年龄(57±17)岁。男14例,女5例;右侧15例,左侧4例;优势侧14例,非优势侧5例;其中并发肘尺管综合征7例。行关节镜下肘关节滑膜清理,取出游离体,进行尺骨鹰嘴和鹰嘴窝,尺骨冠突、冠突窝和桡骨窝骨赘清理磨削成形,对挛缩的关节囊和侧副韧带等给予松解,并发肘尺管综合征病人予以内侧切口尺神经松解原位放置或皮下前置。采用t检验比较术前和术后肘关节视觉模拟疼痛评分(VAS评分)、肘关节平均屈伸活动度和肘关节功能评分(Mayo肘关节功能评分)。结果术后获得随访17例,失访2例,平均随访时间(18±6)个月。16例患者肘关节疼痛和屈伸活动度均有明显改善,1例疼痛改善不明显但活动度改善明显,平均关节活动度由术前(84.2±14.1)°增加为术后(113.1±15.5)°(t=26.182,P0.01),平均VAS评分从术前(4.9±2.1)分降为术后(1.6±0.7)分(Z=4.991,P0.01),Mayo肘关节功能评分从(56.8±13.6)分改善为(80.4±12.5)分(t=23.629,P0.01),1例出现尺神经损伤症状,术后14个月随访时完全恢复,无感染、其他神经损伤等并发症,并发肘尺管综合征病人中6例感觉完全恢复正常,1例明显改善。结论关节镜下肘关节清理松解术可显著缓解疼痛、改善肘关节屈伸活动度与术后功能,并发肘尺管综合征可以通过相应松解有效处理。     

手术治疗成年人股骨髁剥脱性骨软骨炎的临床疗效

目的探讨手术治疗成年人股骨髁剥脱性骨软骨炎的疗效。方法回顾性的分析2010-04—2013-04间接诊的40例成年人股骨髁剥脱性骨软骨炎患者的临床资料,均采用外科手术治疗。术前、术后用Lysholm评分和主观IKDC评分评定膝关节功能。结果 40例患者均获随访,随访时间12~46(26.2±2.6)个月,术后膝关节功能恢复,疼痛明显减轻,患者术后终末随访Lysholm评分和IKDC评分均明显高于术前,差异具有统计学意义(P0.05)。结论对不同时期、不同类型的股骨髁剥脱性骨软骨炎患者,采用手术治疗可取得良好疗效。     

异体关节移植治疗创伤性关节毁损的临床效果

目的观察运用新鲜及冷冻异体关节移植修复关节毁损的效果。方法1977年3月～1993年9月,对13例16个关节创伤性毁损患者进行异体关节移植修复手术。男9例,女4例;年龄17～55岁。其中掌指关节5例5个关节,指间关节6例9个关节,共11例14个关节;肘关节2例,共2个关节。指间关节及掌指关节均为机器挤压伤,2例肘关节为车祸伤,所有患者均为创伤致关节毁损。临床随机分为两组,A组7例8个关节于关节畸形愈合后行新鲜异体关节移植,B组6例8个关节伤后即时行冷冻处理后异体关节移植。于伤后即时至6个月行异体关节移植术。术后对移植关节的活动度、X线片表现及术后8周行免疫学检测。结果A组骨性愈合时间为5～8个月,B组骨性愈合时间为4～6个月。A组术后2年,掌指关节屈曲度为30～40°,指间关节屈曲度为20～30°;术后6～7年,屈曲度仅有10～20°;新鲜肘关节移植1例术后屈肘60°,伸肘0°,前臂旋前30°,旋后30°。B组术后2年,掌指关节屈曲度为60～70°,指间关节屈曲度为40～50°;术后6～7年,屈曲度仍有40～50°;冷冻异体肘关节移植1例术后屈肘90°,伸肘0°,前臂旋前45°,旋后45°。B组关节活动度、X线片表现明显优于A组。两组免疫学比较:A组IL-2为21.64±3.99,CD4/CD8为3.88±0.82。B组IL-2为16.63±3.11,CD4/CD8为2.53±0.23。A组与B组比较差异有统计学意义(P<0.01)。结论以恢复关节的外形、运动及综合性活动而言,冷冻异体骨修复骨关节缺损为一种较好的方法。     

Arthroscopic treatment of osteochondritis dissecans of the capitellum: Report of 5 female athletes

The management of osteochondritis dissecans of the capitellum of the adolescent elbow is still controversial. We report on 5 cases of female high-level athletes aged from 10 to 19 years (4 gymnasts, 1 waterpolo player). All these athletes had a symptomatic osteochondritis dissecans of the capitellum, which was treated arthroscopically in all cases. Follow-up time averaged 5 months (1 to 6.5 months). During the arthroscopy, loose osteochondral fragments of the capitellum and radial head were removed, and the defect was debrided. Thorough evaluation of the anterior and posterior joint including the olecranon fossa was performed. One of the 5 patients had a loose body requiring arthroscopic removal. Within 6 months after surgery, all except 1 elbow, the elbow with a loose body, regained maximum range of motion. Two patients returned to a high level of gymnastics and 1 was considering return. The short-term results of this treatment suggest that arthroscopic debridement of the loose osteochondral fragments provides a good result.Arthroscopy: The Journal of Arthroscopic and Related Surgery, Vol 19, No 2 (February), 2003: pp 210–214     

几丁糖预防肘关节粘附的临床研究

OBJECTIVE: To study the clinical effect of chitosan on prevention of elbow adhesion after elbow arthrolysis. METHODS: Twenty six patients with elbow ankylosis were performed elbow arthrolysis, which divided into two groups, in chitosan group, 12 patients were injected 2% chitosan into the elbow joint cavity, and no chitosan used in the other 14 patients as control group. The average range of extension and flexion of elbow joint was detected to evaluate the clinical results. RESULTS: All patients were followed up 8 to 51 months, averaged 24 months. In the chitosan group, the average range of extension and flexion of elbow joint was restored to 92.9 degrees +/- 20.9 degrees, with an average increase of 55.0 degrees +/- 15.9 degrees compared with preoperation. In the control group, the average range of extension and flexion of elbow joint was restored to 75.4 degrees +/- 17.5 degrees, with an average increase of 38.2 degrees +/- 11.9 degrees. The outcome showed significant difference between the chitosan group and the control group (P < 0.01). CONCLUSION: Chitosan can prevent or reduce elbow adhesion after elbow arthrolysis.     

Bilateral knee and bilateral elbow osteochondritis dissecans

A 12 1/2-year-old white girl presented with a 3-year history of bilateral knee and bilateral elbow pain. Radiographs showed osteochondritis dissecans (OCD) lesions of both patellas and bilateral intra-articular bodies within the elbows--consistent with previous OCD lesions. After unsuccessful conservative management, an arthroscopy was performed on the right knee; the lesion was removed, and a chondroplasty was performed on the patella. There were no operative complications, and the patient did well postoperatively. At 12-week follow-up, a 2+ effusion was found in the right knee. Locking and pain in the left elbow were treated with arthroscopy/arthrotomy, and the 3 loose osteochondral bodies were removed. The patient regained full, painless range of motion of the left elbow. This is the first report of OCD lesions located on both patellas and elbows in an adolescent.     

Elbow Arthroscopy: Where Are We Now?

Elbow arthroscopy has developed over the past several years. Indications have evolved from simple loose body removal to the treatment of rheumatoid arthritis. There have been few published reports of elbow arthroscopy compared to reports of knee or shoulder arthroscopy. Complications are more frequently reported after elbow arthroscopy than after arthroscopy of larger joints; therefore, careful attention to detail is necessary to help prevent neurovascular complications. Elbow arthroscopy can be a useful technique for the orthopaedic surgeon. This review will describe the operative setup and appropriate portal placement. Currently, several different pathologies have been addressed arthroscopically, including loose bodies, arthritis, fracture, instability, and osteochondritis dissecans.     

Guidelines to Becoming an Expert Elbow Arthroscopist

This report presents my guidelines for surgeon training and development of skills in the art of elbow arthroscopy. As elbow arthroscopy becomes more common, it is important to achieve greater levels of experience that will minimize the risk of complications because indications and techniques are growing in number and complexity. Indications for elbow arthroscopy that require diagnosis before open surgery include evaluation of instability; removal of loose bodies, spurs, and plica; irrigation and debridement of infection or open joints; evaluation for arthrofibrosis (with open nerve protection), lateral epicondylitis, arthritis, osteochondritis dissecans, fracture, bursectomy, synovectomy, stabilization, tendon repair, and nerve release or decompression.     

Intraarticular pressure and capacity of the elbow

The compliance, capacity, and the position of minimum intraarticular pressure were measured in 13 thawed, fresh-frozen human elbows. The capacity of the joint capsule was 23 +/- 4 ml. The intraarticular pressure was the lowest at 80 degrees of flexion. Capsular rupture occurred at relatively low intraarticular pressures--80 +/- 42 mm Hg. Knowledge of the capacity of the normal elbow joint combined with the fact that this joint capsule tends to rupture or permit extravasation of fluid into the periarticular soft tissues should be considered when infusing fluids during arthroscopy. Finally, the "resting position" of 80 degrees of flexion minimizes capsular tension and therefore might contribute to the development of joint contracture associated with prolonged immobilization in this position. This would be consistent with the observation that patients with posttraumatic elbow stiffness have an average arc of flexion of 60-90 degrees.     

Treatment of severe osteochondritis dissecans of the elbow using osteochondral grafts from a rib

We treated a patient with extensive osteochondritis dissecans of the elbow by an osteochondral graft from a rib. It had consolidated seven months after operation. When seen at follow-up, after seven years and eight months, the elbow was free from pain with an improvement in the range of movement of 24 degrees.     

Elbow arthrolysis for traumatic arthrofibrosis: a shift towards minimally invasive surgery

The elbow joint needs to be both mobile and stable to exercise its hinge function, which is the key to a normal upper limb. Loss of motion in the elbow joint leads to an exponential functional handicap. Elbow trauma is a common cause of elbow stiffness. Open elbow arthrolysis with release of the capsule has been demonstrated to be a very useful treatment. Arthroscopic elbow arthrolysis has now gained popularity, along with the rapid evolution in elbow arthroscopy. The authors present the preliminary results of this technique in 12 patients, with a mean follow-up of 19.4 months. The range of motion significantly increased from an extension lag of 39.2 degrees and a flexion limited to 115 degrees to an extension lag of 17.9 degrees and a flexion of 131.7 degrees. On average, a 38 degrees gain in range of motion was achieved. This result is comparable with a gain of 40 degrees after open arthrolysis, reported by the senior author in a previous study. The DASH score improved from 39 to 28, but not significantly, and the VAS for pain from 5.5 to 3.4 (significantly). All patients would undergo the procedure again and they experienced a mean subjective improvement of 63.6%. A literature review showed that open and arthroscopic arthrolysis yield a gain of about 44.10 degrees and 31.25 degrees, respectively. The conclusion is that there certainly is a place for arthroscopic elbow arthrolysis.     

Elbow arthroscopy for neglected osteochondritis dissecans of the capitellum

We reviewed results of elbow arthroscopy for neglected osteochondritis dissecans (OCD) of the capitellum. Of more than 140 patients having elbow arthroscopy at our institution, 10 patients (11 elbows) had OCD of the capitellum and fulfilled inclusion criteria. Criteria included symptoms of at least 2 years' duration, loss of motion for at least 6 months, or radiographic evidence of secondary degenerative changes. One patient was lost to follow-up. The remaining 9 (10 elbows) were male patients with a median age of 20 years (range, 15 to 58 years). Follow-up averaged 4.6 years (range, 2 to 8 years). Using a 100-point system, postoperative elbow scores averaged 92 (range, 55 to 100). All patients returned to preoperative activities, though only 8 of 10 believed that surgery resulted in improvement. Elbow arthroscopy for neglected OCD can result in functional improvement. However, results are not as good as those reported with earlier intervention.