电烧伤后肘关节纤维性强直的解剖学基础与临床治疗

目的　探讨电烧伤后肘关节纤维性强直并神经损伤的较好治疗方法。　方法　取30块健康成人肘关节固定标本,进行解剖学观察。对笔者单位10例电烧伤并发肘关节纤维性强直的患者,采用屈、伸肘功能重建的方法进行治疗,即松解尺、桡侧副韧带的前、后束与延长肱二、三头肌肌腱,同时下移内上髁处前臂屈肌群起点的附着点、前置尺神经,以生物力学观察标准进行疗效评价。　结果　通过对健康成人肘关节的解剖学观察可知,如果尺、桡侧副韧带后束与肱三头肌废用性挛缩,可引起肘关节伸直位强直;如果尺、桡侧副韧带前束与肱二头肌废用性挛缩,可引起肘关节屈曲位强直。10例电烧伤患者的术后功能恢复满意。术后随访1—3年,患者肘关节屈伸范围不变,灵活度加强。结论　重建屈、伸肘功能是治疗电烧伤后肘关节纤维性强直的关键,如同时下移内上髁处前臂屈肌群起点的附着点、前置尺神经,可进一步改善关节屈曲与神经嵌压。

The anatomic basis and the clinical treatment of the elbow joint stiffness after electric injury

Objective To explore the optimal method for the treatment of the elbow joint stiffness accompanied with neural injury after electrical injury. Methods Thirty adult cadaver elbows were fixed and dissected to observe the attachments of the ligaments and the muscles around the joint,and its relationship with the major nerves. Ten patients with electric burns with stiffness of the elbow joint were treated by means of loosening the anterior and posterior fascicles of radial and ulnar collateral ligaments,at the same time down shifting the insertion of flexor muscles,replacing the ulnar nerve anteriorly,in order to reconstruct flexor and extension functions of the elbow. The effect was evaluated with biomechanics criteria. Results Through anatomical study,it was revealed that contracture of the posterior fascicles of the radial and ulnar collateral ligaments and tricepts brachii muscle would result in stiffness of the elbow joint,and contracture due to disuse of the two anterior fascicles of the radial and ulnar collateral ligaments and M.bicepts brachii would produce flexion deformity of the elbow joint.Postoperatively, the functions of the elbow joints of all the 10 patients recovered satisfactorily.Follow-up from 1 to 3 years showed no change in the range of flexion and extension movements of the elbows,and on the contrary,mobility of the elbow joints was improved. Conclusion Loosening of the anterior and posterior fascicles of the two collateral ligaments and replacement of insertions of biceps and triceps are pivotal in the treatment of stiffness of the elbow joint . Meanwhile lowering the origins of forearm flexor muscles on epicondylus and replacing anteriorly the ulnar nerve can further improve the flexion ,function of the joint and relieve compression of the nerve.