关节镜下诊治青少年肘关节剥脱性骨软骨炎

目的探讨肘关节镜在青少年肘关节剥脱性骨软骨炎诊断和治疗中的作用。方法2003年5月~2006年2月,应用关节镜诊治肘关节剥脱性骨软骨炎患者11例。男6例,女5例;年龄13~19岁。左侧4例,右侧7例。其中7例有明显外伤史。于伤后7个月~12年手术。术前VAS评分80±10分,屈伸活动度80±10°,旋转活动度100±5°。臂丛神经阻滞麻醉下,经软点、内上、外上等入路,行肘关节探查、游离体取出及清理术。结果术后7~12d,患者均恢复日常生活及工作,无神经、血管损伤等并发症。11例患者均获随访6~18个月,平均12.5个月。参照改良HSS肘关节评分系统进行疗效评定,优7例,良4例。术后末次随访VAS评分32±15分,屈伸活动度110±10°,旋转活动度120±5°,与术前比较差异均有统计学意义(P<0.05)。结论肘关节镜具有损伤小、恢复快、功能改善显著、并发症少等优点,是诊断和治疗青少年肘关节剥脱性骨软骨炎的一种有效方法。

ARTHROSCOPIC DIAGNOSIS AND TREATMENT OF OSTEOCHONDRITIS DISSECANS OF ELBOW JOINT IN ADOLESCENT

OBJECTIVE: To explore the effect of arthroscopy in diagnosis and treatment of osteochondritis dissecans of elbow joint in adolescent. METHODS: From May 2003 to February 2006, 11 patients with osteochondritis dissecans of elbow joint were diagnosed and treated with arthroscopy. There were 6 males and 5 females, aging from 13 to 19 years. The left joints were involved in 4 cases and right joints in 7 cases. Seven patients had obvious history of injury. The interval of injury and operation was from 7 months to 12 years. The score of VAS was 80 +/- 10, the range of flexion and extend of joint 80 +/- 10 degrees, the range of rotation of joint 100 +/- 5 degrees preoperatively. The brachial plexus anesthesia, the elbow hung to traction, soft spot, interna and extra-pathway were given to explore and debride elbow joint and remove corpus liberum. RESULTS: All patients recovered daily life and work 7 to 12 days postoperatively. There were no complications of blood vessel and nerve injuries. Eleven cases were followed up for 6 to 18 months (mean 12.5 months). The results were excellent in 7 and good in 4 according to HSS scoring system. At the final follow-up, the score of VAS was 32 +/- 15, showing statistically significant difference when compared with pre-operation (P < 0.05). The range of flexion and extend of joint was 110 +/- 10 degrees, the range of rotation of joint was 120 +/- 5 degrees post-operatively, showing statistically significant differences when compared with pre-operation (P < 0.05). CONCLUSION: The elbow arthroscopy might be a reliable method to diagnose and treat osteochondritis dissecans of elbow joint in adolescent with minor trauma, quick recovery, significant improving function and less complications.