Functional anatomy of the elbow joint and three-dimensional quantitative motion analysis of the elbow joint

This work consists of two parts. Part One is a three-dimensional study of the passive motion of the elbow joint and revealed that the elbow joint was not a true hinge joint. Part Two is a three-dimensional quantitative motion analysis which was undertaken to compare shoulder and trunk motion in normal subjects with those with contracted elbows. This analysis revealed that shoulder rotation, shoulder abduction, trunk flexion and trunk rotation compensates for a contracted elbow.     

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。     

Arthrolysis of the elbow joint

A stiff elbow is usually defined as having less than 30 degrees in extension or flexion less than 130 degrees. Most activities of daily living are possible if the elbow has a range of motion of 100 degrees (30-130 degrees of flexion, Morrey's arc of motion). Loss of motion of the elbow is not uncommon after trauma, burns, or coma and severely impairs upper limb function. Loss of motion may be difficult to avoid and is challenging to treat. Detailed analysis of the etiology and diagnostic evaluation is of utmost importance for planning any surgical intervention for elbow stiffness. Current operative techniques, such as arthroscopic or open arthrolysis and closed distraction with external fixation (arthrodiatasis), are presented and evaluated. Elbow arthrolysis is a technically demanding procedure, but if indication and techniques are used correctly and surgeon, physiotherapist, and patient are familiar with the procedure, good long-term results may be achieved.     

Arthroscopy of the elbow joint

Clear indications have been recognised for arthroscopic surgery of the elbow since the 1980s. Good indications are loose bodies, mild or moderate restriction of the range of movement and early stages of rheumatoid arthritis. Cartilage diseases such as Panner disease or focal radial chondropathy can be treated by arthroscopic debridement and microfracturing. Impingement syndromes affecting the lateral compartment of the joint respond well to resection of synovial plicae. The technical demands of endoscopic arthrolysis procedures for joints with mild or moderate restriction of range of movement are extremely heavy; only experienced surgeons should operate on such patients. Arthroscopy of the elbow joint should be carried out only by operators who have already gained experience in other joints, because of the close relations of nerves and vessels in the elbow. A rigorous standard should be followed in planning the procedure and in creation of the portals and performance of the diagnostic round-up in the joint, to make it possible to work purposefully and quickly, and thus with minimum complications.     

Dislocation of the elbow joint

Summary Although dislocation of the elbow is a common injury, it has been the subject of very few papers in the orthopaedic literature during the last 20 years. The recommendations for treatment have usually been conservative but in later years wider indications for surgical treatment with ligament repair have been recommended. Seventy-two patients with simple elbow dislocations (38) and fracture dislocations (34) treated at the departments of orthopaedic surgery in Göteborg 1975–1980 were reviewed. Results for patients with simple dislocations were excellent and good in 85 per cent and no difference could be recorded between those treated by surgery and those treated conservatively. Results after treatment of fracture-dislocations were generally worse and only 41 per cent achieved excellent or good results. We concluded that most simple dislocations should be treated conservatively with closed reduction followed by a short period of immobilization. In fracture-dislocations surgical repair of the elbow ligaments should be considered especially when the radial head has been excised.

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Zusammenfassung Bei einem bis heute in der Literatur noch uneinheitlichen Therapiekonzept für Ellengelenksluxationen bzw. Luxationsfrakturen versuchen die Verfasser, ihr Vorgehen anhand von 89 Patienten darzulegen. Einfache Dislokationen wurden geschlossen reponiert und grundsätzlich für 2 bis 3 Wochen immobilisiert. Redislokationen wurden nicht beobachtet. Luxationen des Ellengelenkes, die mit einer größeren Absprengung des Processus coronoideus oder einer Fraktur des Radiusköpfchens einhergingen, wurden ausnahmslos operativ angegangen, da nach Auffassung der Autoren eine konservative Behandlung der Frakturen oft zu Reluxationen neigt. Zeigen die Nachkontrollen von insgesamt 72 Patienten für die einfachen Luxationen in 85% der Fälle gute bis sehr gute Behandlungsergebnisse, so resultieren bei den Luxationsfrakturen stets beachtliche Funktionseinbußen.

     

Endoprosthetic joint replacement of the contracted elbow joint

In a retrospective study 14 patients were reviewed 63 months after the implantation of a semi-constrained total elbow prosthesis in fourteen stiff or ankylosed elbows with a preoperative range of elbow motion of 30 degrees or less. The result, according to the Mayo Elbow Performance score, was excellent for four elbows, good for four, fair for one, and poor for five. The average arc of flexion improved from 7 to 68 degrees postoperatively with an average increase of 34 degrees in flexion, and 27 degrees in extension. There were seven complications affecting seven of the 14 elbows and four of these seven elbows underwent a revision procedure. Replacement for a stiff elbow is the least predictable, has the lowest overall rate of success and highest complication rate, than any other procedure. Nevertheless, these disadvantages must be placed in the context of alternative intervention options. The semiconstrained total elbow arthroplasty seems to be a useful option for patients older than 50 years with intrinsic stiffness involving more than 50% of the articular surface and with an ankylosed or very stiff elbow.     

肘关节牵伸成形术治疗外伤后屈肘挛缩畸形(附3例报告)

[目的]探讨肘关节牵伸成形术治疗外伤后屈肘挛缩畸形的方法与效果。[方法]参考伊里扎洛夫技术研制了环状弹性肘关节牵伸器,2003年3月~2005年7月治疗肘关节屈曲挛缩畸形3例,男1例,女2例,年龄16~17岁。平均病程12年4个月,术前屈肘畸形(以肘伸直0°位计算)1例70°,2例45°。手术操作不做皮肤切口,仅是在上肢实施穿针、安装外固定关节牵伸器的过程,注意牵伸器的关节铰链对准肘关节的伸屈旋转中心。术后逐渐旋转肘关节前的螺纹牵伸杆,使其产生持续的牵伸力,缓慢矫正屈肘挛缩畸形,在牵伸矫正过程中,定期X线检查肘关节的位置。[结果]3例病人术后牵伸平均32d,肘关节最终伸直到0°~10°位,平均矫正屈肘挛缩45°,肘关节屈伸运动弧从术前75°增加到115°,外观与功能皆达到满意结果。[结论]肘关节微创牵伸成形术可有效的矫正肘关节屈曲挛缩畸形,改善肘关节功能。     

Open fractures of the elbow joint

Both in open and in closed elbow fractures, anatomical joint reconstruction and rigid internal fixation, which permit early initiation of motion, are essential for good joint function. However, in open distal intraarticular humerus fractures this is more difficult to achieve, owing to the high rate of comminuted types C 2 and C 3 fractures. In addition, the extensive soft tissue lesions often mean that physiotherapy cannot be started until later than would otherwise be desirable. This retrospective study shows that the functional results in 60 patients operated on for correction of open distal intraarticular humerus fractures were worse (1/3 "excellent/good", 2/3 "moderate/poor") than those in patients treated for closed fractures. Complications included superficial infection in 7 patients, osteitis in 11, late instability in 10, fatigue failure of the implants in 5, and non-union in 10 patients.     

Injuries of the elbow joint]

Injuries of the elbow joint increase along with increased athletic activity and life expectancy. Knowledge of anatomy and biomechanics is important for understanding injury patterns, specific diagnosis, and therapy. Here we classify the most frequent elbow injuries such as dislocation, ligamentous instability, and fracture of the radial head, processus coronoideus, olecranon, and distal humerus based on joint anatomy, biomechanics, clinical examination, and imaging. Specific therapies are described.     

Functional anatomy of the elbow joint

An attempt has been made to describe the combined action of the bony elements of the elbow joint, together with the capsular ligaments, as a single unit. Particular emphasis is laid upon the mechanisms that prevent abrupt limitation of movement. The account of the periarticular structures, including the adjacent muscles, is followed by a discussion of the various possible surgical approaches to the joint. Finally, a general survey is given of the kinematics and kinetics of the elbow joint. It is suggested that the distribution of the hyaline articular cartilage and the density of the underlying bone are morphological reflections of the stresses acting upon the joint. It follows that the axial pressure acts upon both the ulnar and the radial components of the elbow; therefore, if the joint is to remain stable, at least one of its distal bony elements must be functionally effective.