Arthroscopy for arthritis of the elbow

Elbow arthroscopy has been used to treat patients with arthritis since the initial report of its efficacy by Savoie and colleagues in 1992. It has proved extremely useful as an adjunct treatment to decrease symptoms and increase function. A thorough knowledge of anatomy is essential for this modality to be used successfully. In young or active patients, it is the treatment of choice for arthritis of the elbow.     

关节镜手术治疗肘关节伸直受限的临床研究

目的 探讨关节镜下手术治疗肘关节伸直受限的临床疗效.方法 2007年9月至2009年12月收治21例肘关节伸直受限患者,病程中均有慢性肘关节过伸落空损伤史,有过伸受限合并疼痛症状,平均伸直滞缺18.2°(10°～25°).全部采用五通道入路法行关节镜探查手术,术中清理前关节腔,必要时松解前方关节囊,清除肱骨滑车骨赘,行肱骨鹰嘴窝和尺骨鹰嘴成形术.术后常规抗感染、康复训练及预防骨化性肌炎治疗.随访时对比手术前、后的肘关节活动度,并采用Mayo评分表对肘关节功能进行评价,总结术后并发症.术前Mayo评分良13例,中5例,差3例.结果 21例患者术后随访6～29个月(平均19.7个月).21例患者肘关节功能恢复良好,过伸度均得到改善,疼痛症状消失.平均伸直滞缺2.4°(0°～5°).术后Mayo评分优17例,良4例,中0例,差0例.未见神经并发症.结论 肘关节镜下手术具有创伤小、出血少、并发症少的特点,配合合理的康复训练,能有效改善肘关节的功能,是治疗肘关节伸直受限的有效术式.     

Arthroscopy of the elbow

A technique of diagnostic and surgical arthroscopy of the elbow is presented, and the normal intraarticular anatomy as viewed from the anterolateral, anteromedial, and posterolateral portals is described. A preliminary study of 12 patients who underwent surgical arthroscopy of the elbow demonstrated that removal of loose bodies produced the best objective and subjective results. Less satisfactory results were obtained when procedures such as capitellum and radial head chondroplasties were performed. Using a preoperative and postoperative point accumulation rating system for four objective and four subjective criteria, the following results were noted. Before surgery 50% of the patients objectively rated their elbows as satisfactory (excellent or good), whereas postoperative ratings increased to 83%. Subjectively, 17% rated their elbows as satisfactory before surgery, improving to 58% satisfactory ratings postoperatively. The only complication was a transient median nerve palsy caused by the extracapsular extravasation of a local anesthetic. From this preliminary study, it was concluded that attention to detail is essential in performing a safe, reproducible arthroscopic examination of the elbow, that arthroscopy of the elbow is an effective diagnostic procedure, and that operative elbow arthroscopy is effective in the treatment of certain elbow disorders.     

Rheumatoid arthritis of the elbow

Rheumatoid arthritis (RA) is the most common form of inflammatory arthropathy. RA?is considered a disease of synovial joints, although it can cause various extra-articular manifestations. The synovium appears to be the primary target; however, investigations are ongoing to determine the exact etiology and pathoanatomy.     

肘关节镜下清理术治疗肘关节骨关节炎的早期疗效

目的探讨肘关节镜下清理术治疗肘关节骨关节炎的早期疗效以及术中第一入路的选择。方法2010年5月至2013年5月,我院收治16例肘关节骨关节炎患者,男14例,女2例;年龄22-58岁,平均45岁。右肘15例、左肘1例,均单侧发病。采用侧卧位,以后正中入路作为第一入路,辅以后外侧和近端内、外侧入路行肘关节镜下清理术。分别测量术前、术后肘关节伸直角度、屈曲角度、活动度,应用Mayo肘关节功能评分（Mayo elbow performance score,MEPS）评价疗效。结果所有患者均获随访,切口均甲级愈合,无神经及血管损伤并发症。肘关节伸直角度、屈曲角度、活动度及MEPS值较术前明显改善（P〈0.05）。术后MEPS值结果：优9例,良4例,中3例,优良率达81.25%。结论肘关节镜下清理术治疗肘关节骨关节炎,可以明显增加关节活动度,改善关节功能,早期疗效较好。采用侧卧位,以后正中入路作为第一入路,辅以后外侧和近端内、外侧入路,术中操作方便,安全。     

关节镜下手术治疗肘关节僵硬

目的：探讨关节镜下手术治疗肘关节僵硬的临床疗效。方法：2010年11月至2012年12月,对纳入的27例肘关节僵硬患者,行肘关节镜下关节腔清理关节囊松解术治疗。其中男18例,女9例;年龄24~54岁,平均35.7岁。术后配合镇痛及理疗康复锻炼,使用Mayo评分系统进行疗效评价。结果：27例术后均获随访,时间12~18个月,平均13.5个月。肘关节平均最大屈曲活动度由术前（61.5±30.1）°改善为术后（102.5±20.1）°,平均最大伸直活动度由术前（34.8±12.1）°,改善为术后（16.3±16.1）°,总平均活动范围由术前（34.2±21.0）°改善为术后（84.9±9.2）°。根据Mayo评分系统进行疗效评价,术前平均（60.5±13.4）分,术后平均（88.7±6.3）分,术后评分提高;其中优10例,良13例,一般4例,差0例。结论：关节镜下肘关节松解手术具有创伤小、出血少、恢复快及视野清晰等优点,可有效改善肘关节活动度,是治疗肘关节僵硬的有效手术方式。     

关节镜下肘关节松解术

目的探讨关节镜下松解治疗肘关节活动受限的适应证、临床疗效及预后。方法2003年12月至2005年5月间收治17例创伤后肘关节活动受限患者,关节镜下行肘关节松解术。术中清理关节腔,清除骨赘及影响活动的骨性阻挡,去除鹰嘴窝内瘢痕,松解挛缩的关节囊,恢复肘关节活动度。术后镇痛泵配合下进行康复训练及理疗。对比手术前后肘关节伸屈活动度,行Mayo评分,并观察术后并发症。结果术后随访7～18个月(平均9.7个月),17例患者肘关节活动度均有不同程度改善。术后最大主动伸直位角度平均为5°±5°,较术前改善36°±19°;术后最大主动屈曲位角度平均为113°±21°,较术前增加28°±18°。手术前后最大主动伸直位及屈曲位角度差异有统计学意义(P<0.01)。Mayo评分:术前,良3例,中10例,差4例;术后,优4例,良6例,中6例,差1例。除1例患者术后出现一过性尺神经麻痹,无其他并发症。结论关节镜下肘关节松解术具有创伤小、出血少、并发症少的特点,配合合理的康复训练,能显著改善肘关节的功能,是治疗肘关节活动受限的有效术式。     

Techniques of Wrist Arthroscopy

Wrist arthroscopy is a promising new technique for the evaluation of wrist pain or dysfunction. Cadaveric wrist specimens were used to devise safe and advantageous entry portals for arthroscopy and to establish respective advantages for each portal. Thirty-five clinical cases were used to correlate the laboratory experience and to refine a reproducible surgical technique. Seven portals are useful: five in the radiocarpal interval, one in the midcarpal area, and one in the distal radioulnar joint space. Detailed wrist anatomy is reviewed in this paper and must be thoroughly understood to interpret arthroscopic views. Blunt subcutaneous dissection protects cutaneous nerve branches at the various portals. Intraoperative photographs illustrate the excellent perspectives achieved using these techniques.     

(ii) Total elbow arthroplasty

Elbow arthroplasty has an important role in the treatment of many conditions affecting the elbow, including inflammatory arthritis, osteoarthritis, fracture and instability. The types of implant differ in the degree of constraint they provide. Some are linked and highly constrained implants, whereas others have a “sloppy hinge” which allows some varus/valgus play. Yet others are completely unlinked and provide the least constraint, relying on ligament and muscle balance for stability. A variety of implants have achieved good results in terms of pain relief and range of movement, which usually leads to significant functional benefit to the patient.However, this surgery is not without risk and the main complications include loosening, infection, instability, dislocation and nerve dysfunction. As with other forms of arthroplasty, but particularly the elbow, it is important to scrutinise the indication for surgery when considering the results of elbow arthroplasty; the majority of procedures are performed for inflammatory arthritis. The precise difference in outcome between unlinked, linked and sloppy articulations appears to be small and the exact role for each implant type is yet to be precisely defined.     

肘关节镜治疗非运动员肘骨关节病

目的 对非运动员患者肘骨关节病进行关节镜清理手术,评估其临床治疗效果. 方法 1999年1月～2006年1月,我所对26例非运动员患者肘骨关节病施行关节镜清理手术.其中23例随访4～86个月,平均23个月.23例均有肘关节疼痛,伸屈范围受限,4例有尺神经炎症状. 结果 术后20例(87%)肘疼痛消失或仅有轻微疼痛,3例(13%)肘仍有中等程度疼痛.肘关节平均活动范围从术前的99.6°(65°～135°)提高到术后的122.1°(80°～150°).按Mayo肘关节评分标准,优16例,良4例,中3例,优良率87%.3例尺神经炎症状消失,另1例尺神经炎症状存在,但无加重.患者非常满意14例,满意6例,不满意3例,满意率为87%.术后1例迟发性尺神经炎.结论 肘关节镜清理手术是治疗非运动员肘骨关节病的有效方法,可以明显缓解肘关节疼痛,一定程度上改善关节活动范围,术后可以早期康复.     

Anterior interosseus nerve injury following elbow arthroscopy

Elbow arthroscopy is becoming an increasingly invaluable tool for both evaluation of and treatment of a variety of interarticular disease processes. Case reports have documented radial and posterior interosseus injuries following anterior capsular release. To date, this is the first report of an anterior interosseus nerve injury following arthroscopic surgery of the elbow. Arthroscopic surgery offers unparalleled visualization of the multiple articulations and facets of the elbow. It has been reported as useful for removal of loose bodies, synovectomy, release of arthrofibrosis, and the treatment of osteochondritis dessicans. However, the technique does require thorough knowledge of neurovascular structures about the elbow as well as appreciation of the protective layers including the capsule, brachialis, and brachioradialis muscles. This report documents direct injury to the anterior interosseus branch of the median nerve during an elbow debridement and synovectomy in a 65-year-old patient with rheumatoid arthritis.     

肘关节镜"序贯五入路法"的有效性与安全性分析

目的 探讨肘关节镜"序贯五入路法"在肘关节损伤和疾病治疗中的有效性与安全性.方法 2004年4月至2007年5月期间收治53例肘关节镜手术患者,包括肘关节强直24例,骨折15例,肘关节游离体7例,桡骨小头脱位2例,关节结核8例,类风湿关节炎4例,骨化性肌炎5例,色素沉着绒毛结节性滑膜炎3例,滑膜软骨瘤1例.手术入路采用"序贯五入路法",由肘后"软点"建立第一入路后,关节镜监视下于前外侧建立第二入路,通过第二入路绕过冠突由内向外建立第三入路.再在肘后肱三头肌腱两侧建立后外侧人路和后内侧人路,作为第四、五入路.按顺序探查肘关节腔,并进行相应处理.其中3例转为切开手术.术后采取无痛性康复训练,对手术前、后肘关节Mayo功能评分进行比较.结果 46例患者术后获6～34个月(平均11.65个月)随访,Mayo评分:术前45～85分,平均(66.8±11.5)分,良14例,可21例,差11例;术后55～100分,平均(84.5～10.5)分,优16例,良21例,可8例,差1例.术后2例出现一过性神经麻痹症状,其中尺神经深支和桡神经深支各1例,3个月后恢复.结论 采用"序贯五入路法"肘关节镜下显露满意、视野清晰,手术效果好;手术入路安全,并发症少,值得在肘关节镜手术中推广使用.     

关节镜下治疗肘关节骨性关节炎伴僵硬短期疗效观察

目的探讨肘关节镜下治疗肘关节骨性关节炎伴关节僵硬的临床疗效。 方法回顾性分析2015年5月至2018年6月期间于乌海市人民医院收治肘关节骨性关节炎伴肘关节僵硬的患者17例,所有患者均肘关节镜下行滑膜骨赘清理、关节囊松解、游离体取出、关节结构成型,术后均行专业康复功能训练,观察比较围手术期前、后肘关节视觉模拟评分（visual analogue scale,VAS）、关节活动度、肘关节功能Mayo评分和美国特种外科医院膝关节评分（hospital for special surgery knee score,HSS）的差异,评价其临床疗效。 结果术后均无神经血管损伤、肘关节副韧带损伤、切口愈合不良、感染、异位骨化等术后并发症的发生。所有患者在术后12个月随访时进行评估,VAS评分术前（6.17±1.07）分,术后（2.94±0.65）分;肘关节Mayo评分术前（44.41±3.42）分,术后（93.23±1.71）分;HSS评分术前（45.29±6.69）分,术后（88.41±2.59）分,差异均有统计学意义;术后关节屈伸及旋转活动度显著改善。 结论应用关节镜技术治疗肘关节骨性关节炎伴肘关节僵硬能够显著改善肘关节功能,具有创伤小、恢复快、疗效可靠等优点。     

局部使用氨甲环酸在关节镜下肘关节松解中的临床效果

目的观察局部应用氨甲环酸在关节镜下肘关节松解术后的疗效。 方法2018年3月至2020年2月对61例肘关节僵硬患者行关节镜下肘关节松解术，根据入院时间及术中是否局部使用氨甲环酸分为A、B两组，A组患者2018年3月至2019年2月进行手术，术中未局部使用氨甲环酸；B组患者于2019年3月至2020年2月行手术，术中使用氨甲环酸关节腔灌注。术后比较两组引流血量、视觉模拟评分法（visual analogue scale/score, VAS）、肘关节活动度、Mayo肘关节功能评分等指标。 结果B组患者术后第1天、第2天引流及总引流量均低于A组，其中B组术后总引流量（45±35）ml，A组为（109±76）ml，差异有统计学意义（P< 0.05）。两组患者术后肘关节活动均明显改善，末次随访B组活动范围丢失角度明显小于A组，B组7°±9°，A组15°±14°，差异有统计学意义（P<0.05）。 结论局部应用氨甲环酸可以有效减少关节镜下肘关节松解术后关节腔引流量、术后早期疼痛及术后关节活动范围丢失，利于肘关节术后功能康复。     

关节镜下松解及清理术在肘关节屈伸功能障碍方面的应用

目的探讨肘关节镜下软组织松解及清理术在肘关节屈伸功能障碍方面的应用。方法2001年8月至2003年12月,肘关节屈伸功能受限患者15例,男11例,女4例;年龄21～63岁;病程8个月～20年。肘关节屈曲角度为15°￣60°,平均30.4°;伸直角度为-80°～-20°,平均-51.2°。关节内骨赘伴游离体4例,陈旧性桡骨头骨折2例,陈旧性尺骨鹰嘴骨折2例,陈旧性肱骨髁上骨折3例,退行性变4例。臂丛麻醉下,经肘内上、外上入路切开,关节镜下均可见充血增生的滑膜及软组织粘连,关节软骨退变、剥脱8例,关节内增生骨赘伴游离体形成5例,肘关节前方瘢痕骨化2例。刨削滑膜粘连带,取出增生骨赘及游离体。检查关节活动度,若肘关节伸直受限,则对前方软组织及关节囊松解;若屈曲受限,则另经后直入路(鹰嘴尖上3cm)进入肘关节,对后方关节囊进行松解。结果术后7～14d,患者均恢复日常生活及工作。1例术后出现尺神经暂时性麻痹,3个月后恢复。无一例出现神经、血管损伤。15例患者均获随访,随访时间7～20个月,平均14.1个月。末次随访时,关节屈曲角度为70°￣120°,改善60.5°;伸直角度为-20°￣-5°,改善37.6°。参照改良HSS肘关节评分系统进行疗效评定,优7例,良5例,失败3例。结论肘关节镜下软组织松解及清理术可改善肘关节屈伸功能障碍。     

Arthrodesis of the elbow

Elbow arthrodesis (EA) is a procedure reserved for the salvage of failed elbow reconstruction or elbow injuries that defy reconstruction of a useful joint. Although arthrodesis of some joints is often straightforward and predictable, EA is technically difficult and associated with a high rate of complications. Furthermore, a successful EA does not translate to a gratifying clinical success. The functional limitations to activities of daily living and personal care are significant.     

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.     

Arthroskopie des schultergelenks

Zusammenfassung In den vergangenen 5 Jahren hat die diagnostische und operative Schulterarthroskopie in der Traumatologie und Orthopädie zunehmend an Bedeutung gewonnen. Die Indikation mu streng und exakt gestellt und die Technik nach einem einheitlichen und reproduzierbaren Prinzip durchgeführt werden. Verletzungen des Limbus glenoidalis (v. a. nach erstmaliger traumatischer Schulterluxation bei zungen Patienten), Rotatorenmanschettenläsionen, Behandlung bei bakteriellen Infektionen und unklare posttraumatische Schmerzen sind heute klare Indikationen fur die diagnostische und operative Schulterarthroskopie. In der Behandlung von krankheitsbedingten Veränderungen am Schultergelenk ist die Arthroskopie ebenfalls nicht mehr wegzudenken. Keine andere Untersuchung liefert so viele und so genaue Informationen. Neben der exakten Diagnosestellung bieten die arthroskopischen Operationen am Schultergelenk die Möglichkeit einer gleichzeitigen und definitiven Therapie. Die Indikation sollte daher großzügig gestellt werden, trotz einer Komplikationsrate von rund 5%.

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Arthroscopy of the shoulder

Diagnostic and operative arthroscopy of the shoulder joint has gained considerable importance in traumatology and orthopedic surgery over the last years. Injuries of the limbus glenoidalis, in particular traumatic shoulder luxation, injuries of the rotator cuff, infection of the glenohumeral joint and unclear posttraumatic pain are indications for diagnostic and operative arthroscopy. Arthroscopy of the shoulder is a procedure, which offers exact diagnosis and the possibility of immediate surgery at the same time. The technique of the shoulder joint arthroscopy has to be carried out carefully and according to a standard protocol. The complication rate of around 5% of shoulder arthroscopy has not to be neglected.

     

关节镜技术治疗原发性肘关节骨关节炎术后残余症状分析和预防措施

目的探讨关节镜技术治疗原发性肘关节骨关节炎（osteoarthritis,OA）术后残余症状和预防措施。 方法回顾性分析2016年1月至2018年9月,采用肘关节镜技术对本院骨科收治的28例原发性肘关节OA患者行关节清理和松解手术治疗,其中男26例、女2例,平均年龄为51.6岁（33 ~ 74岁）。依据肘关节临床症状和CT造影结果对肘关节OA进行分期：Ⅰ期4例,Ⅱ期7例,Ⅲa期11例,Ⅲb期6例,Ⅳ期0例。合并尺神经炎患者10例。通过视觉模拟评分（visual analogue score,VAS）、运动弧、Mayo肘关节功能评分（Mayo elbow performance score,MEPS）对肘关节术后疗效进行评估。采用秩和检验方法进行组间比较,检验水准α=0.05。 结果28例患者均获得门诊随访,平均随访时间12.5个月（6 ~ 23个月）。末次随访时,88.9%（85% ~ 100%）的满意度和62%患者重返原工作,78.6%（22/28例）肘关节OA患者术后伴有残余症状,活动受限11例（39.3%）、疼痛感6例（21.4%）、疲劳感14例（50%）、酸胀感14例（50%）、弹响感2例（7.1%）、麻木感3例（10.7%）。随着肘关节OA分期进展,残余症状发生率越高。各期患者VAS评分、运动弧和MEPS评分改善差异无统计学意义（P>0.05）,Ⅲb期患者VAS评分高于其余三组,MEPS评分和运动弧低于其余三组,差异均有统计学意义（P<0.05）。 结论尽管肘关节镜技术能够让肘关节OA患者获得满意疗效,但是肘关节OA患者术后肘关节残余症状仍不可忽视,这可能与肘关节OA疾病进展有关,只有术前临床功能、影像学技术的详尽评估和手术指征的良好把握才能获得更好的临床疗效。