创伤后肘关节僵硬合并异位骨化手术疗效评价

目的评价手术治疗对创伤后肘关节僵硬合并异位骨化患者的治疗效果。方法 2008年7月至2010年12月,16例创伤后肘关节僵硬合并异位骨化患者进行手术治疗。其中,男12例,女4例,平均年龄38.1岁(14⁵9岁),手术松解距受伤时间8.9个月(659岁),手术松解距受伤时间8.9个月(6¹9个月)。所有病例行肘关节松解、异位骨化切除术,术后由同一组康复师训练,应用吲哚美辛预防异位骨化复发。测量患者术前、术后的肘关节屈伸、前臂旋转角度,并进行Mayo评分。术后由经过培训的专业医生进行标准化随访,评估疗效。结果肘关节屈伸活动度平均由术前32°±17.4°提高到108°±16.7°(t=13.295,P=0.000),旋转活动度由术前45°±8.8°提高到80°±11.0°(t=16.051,P=0.000),Mayo评分由术前平均(52.0±11.2)分提高到(82.0±8.1)分(t=8.722,P=0.001),术前、术后评分有统计学差异。有1例出现异位骨化的复发,2例采用外固定架后出现外固定尺骨针孔处骨折。结论异位骨化切除和肘关节松解术对治疗合并异位骨化创伤后肘关节僵硬的疗效满意。

Effect of surgical treatment on post-traumatic elbow stiffness with heterotopic ossification

Objective To evaluate therapeutic results of surgical treatment of posttraumatic elbow stiffness with heterotopic ossification.Methods A retrospective review of analysis was performed 16 case of patients who underwent open surgical treatment for posttraumatic elbow stiffness by the senior author from July 2008 to December 2010. The study group included 12 males and 4 females, with an average age 38.1 years （range 14 to 59 years）. The time from injury to surgery averaged 8.9 （rang 6 to 19） months. We performed elbow open release with excision of the heterotopic ossification. The patients were given indomethacin for 6 weeks after operation. We examined elbow range of motion and used Mayo Elbow Performance Score （MEPS） for evaluations before and after operation.Results The range of flexion to extension of the elbow improved 32°±17.4° to 108°±16.7°. The range of pronation to supination improved from 45°±8.8° to 80.0°±11.0°. The MEPS improved from 52.0±11.2 to 82.0±8.1 （t=8.722, P＆lt;0.001） and there were significant differences before and after surgery. Recurrence of heterotopic ossification occurred in one of sixteen cases. Two cases fracture at ulna pinhole with hinged external fixation.Conclusion Open elbow release with excision of heterotopic ossification is a valuable procedure for post-traumatic stiffness.