肘关节松解术结合带轴外固定支架治疗创伤后肘关节僵硬

目的 探讨应用关节松解术结合带轴外固定支架治疗创伤后外源性肘关节僵硬的临床效果.方法 2006年2月至2008年4月采用肘关节松解术加带轴外固定支架治疗16例创伤后肘关节僵硬患者,男10例,女6例;年龄16-42岁,平均30.5岁.原始损伤:肱骨髁上骨折3例,肱骨髁间骨折4例,尺骨冠状突骨折1例,桡骨小头骨折5例,孟氏骨折3例.受伤至松解手术时间平均为13个月.11例采用肘关节外侧入路,4例采用肘关节内侧入路,1例采用内外侧联合入路进行肘关节松解术,术中保留维持关节稳定的主要韧带,彻底清除影响关节活动的因素,恢复关节活动度.松解完成后以带轴外固定支架固定肘关节,早期进行康复锻炼.结果 16例患者术后获平均16个月(13～27个月)随访.所有患者关节活动度从术前平均34°±26°恢复到术后92°±14°差异有统计学意义(t=4.351,P<0.05).Mayo评分由术前平均(42±11)分增加到术后(84±16)分,其中优3例,良8例,中3例,差2例,优良率68.8%,例(87.5%)患者关节功能得到明显改善.术后未发生感染、肘关节不稳定等并发症.1例患者出现短暂的尺神经麻痹,2个月后症状消失.结论 肘关节松解术结合带轴外固定支架治疗创伤后肘关节僵硬可维持肘关节的稳定性和特有位置,可早期进行功能锻炼,促进肘关节功能的恢复.

Arthrolysis and a hinged external fixator for posttraumatic elbow stiffness

Objective To study the clinic results of arthrulysis and a hinged external fixator for treatment of posttraumatic elbow stiffness. Methods From February 2006 to April 2008,we treated 16patients,10 males and 6 females with an average age of 30.5 years(16 to 42 years),with open arthrolysis and a hinged external fixator.Flexion deformity was observed in 11 patients.The mean interval between trauma and arthrolysis was 13 months.After radiological examination,the lateral Kocher incision was used in 11 patients.the medial incision in 4 and the medial and lateral incision in one.The operation was to eliminate all the factors affecting the joint movement and to restore the range of motion(ROM)of the elbow.Early rehabilitation was encouraged after a hinged external fixator Was applied. Results After an average followup peried of 16 months,the mean ROM improved from preoperative 34°±26°to postoperative 92°±14° (P<0.05).The Mayo elbow performance score(MEPS)improved from preoperative 42 ±11 to postoperatire 84±16(t=4.351,P<0.05).No such complications as iatrogenic elbow instability and incision infection were discovered. Conclusion Arthrolysis and a hinged external fixator can keep stability of the elbow and its specific position,allowing early rehabilitation to promote functional recovery of the elbow.