外固定支架辅助松解治疗创伤后肘关节僵硬

目的 探讨外固定支架在治疗肘关节僵硬中的作用. 方法 自2007年1月至2009年12月,共诊治25例创伤后肘关节僵硬患者.僵硬分级:1级10例,2级12例,3级3例.术前肘关节活动度( rang of motion,ROM)0°～75°,平均33.4°,其中12例＜30°.对1级僵硬行麻醉下外固定支架辅助下的松解,未采用切开松解；2级予切除异位骨化+外固定支架辅助松解；3级予截骨内固定术(+异位骨化切除)+外固定支架辅助松解.术后带外固定架积极康复训练.结果 本组患者术中松解后即刻ROM平均105.6°,较术前ROM显著增加(P＜0.05),屈曲均达到110°以上.未发现肘关节不稳定.术后平均随访6个月,其中1例于术后3周锻炼时发生尺骨骨折而中断随访,1例因尺神经麻痹,至最终屈曲度仅约80°,予排除.平均ROM从术前的33.4°(0°～75°)增加到末次随访时的97.4°(70° ～130°)(P＜0.05).末次随访时ROM较即刻活动度仅有0° ～15°的丢失(平均8.2°,P＞0.05)；最大屈曲度均达100°以上. 结论 外固定支架辅助下的肘关节松解具有微创或无创、增加肘关节的关节间隙、恢复术中可控制的关节最大活动度、维持关节稳定性并保护侧副韧带及内固定、防止术后康复过程中活动度再丢失等优点,可作为创伤后肘关节僵硬治疗的一种有效选择.

Arthrolysis of posttraumatic elbow stiffness with assistance of external fixator

Objective To investigate the value of external fixator in the treatment of posttraumatic elbow stiffness.Methods From January 2007 to December 2009,25 patients with posttraumatic elbow stiffness received surgical arthrolysis with assistance of external fixator.There were 10 patients with grade 1 stiffness,12 patients with grade 2 stiffness and three patients with grade 3 stiffness.The range of motion (ROM) was 0°-75° ( average 33.4°) preoperative,with ＜ 30° in 12 patients.For the patients with grade 1 stiffness,intraoperative distraction with an external fixator rather than open arthrolysis was performed ; for the patients with grade 2 stiffness,the heterotopic ossification was removed through a limited approach before the external fixator was applied; for the patients with grade 3 stiffness,additional osteotomy and internal fixation before arthrolysis were performed.After operation,there was a rehabilitation phase,followed by mobilization of the elbow joint under protection of the external fixator for a mean period of six weeks.Results The intraoperative mean ROM was 105.6°,which was significantly improved than that before operation (P ＜0.05).The maximal flexion degree was above 110°in all patients.No instability occurred.Two patients were excluded from the follow-up:one had ulna fracture two weeks after operation due to an incorrect placement of the pin,and additional internal fixation was then carried out;another patient had numbness in the ulna side when flexed the elbow after arthrolysis,and the ulna nerve transposition was performed through another operation.Other patients were followed up for a mean period of six months.At the latest follow-up,the mean ROM was 97.4°( range,70°-130°),significantly improved than that before operation (P ＜ 0.05 ),and lest 8.2°on average (0°-15 °) compared with the intraoperative ROM (P ＞ O.05).The maximal flexion in all patients was above 100° Conclusion With the advantages of minimal invasive or noninvasive,indirect capsular traction,stability maintenance during the movement,and prevention of the motion loss during the rehabilitation,arthrolysis of the elbow joint with the use of external fixation frame can be a good alternative in the treatment of posttraumatic elbow stiffness.