关节镜技术治疗原发性肘关节骨关节炎术后残余症状分析和预防措施

目的探讨关节镜技术治疗原发性肘关节骨关节炎（osteoarthritis,OA）术后残余症状和预防措施。 方法回顾性分析2016年1月至2018年9月，采用肘关节镜技术对本院骨科收治的28例原发性肘关节OA患者行关节清理和松解手术治疗，其中男26例、女2例，平均年龄为51.6岁（33 ~ 74岁）。依据肘关节临床症状和CT造影结果对肘关节OA进行分期：Ⅰ期4例，Ⅱ期7例，Ⅲa期11例，Ⅲb期6例，Ⅳ期0例。合并尺神经炎患者10例。通过视觉模拟评分（visual analogue score,VAS）、运动弧、Mayo肘关节功能评分（Mayo elbow performance score,MEPS）对肘关节术后疗效进行评估。采用秩和检验方法进行组间比较，检验水准α=0.05。 结果28例患者均获得门诊随访，平均随访时间12.5个月（6 ~ 23个月）。末次随访时，88.9%（85% ~ 100%）的满意度和62%患者重返原工作，78.6%（22/28例）肘关节OA患者术后伴有残余症状，活动受限11例（39.3%）、疼痛感6例（21.4%）、疲劳感14例（50%）、酸胀感14例（50%）、弹响感2例（7.1%）、麻木感3例（10.7%）。随着肘关节OA分期进展，残余症状发生率越高。各期患者VAS评分、运动弧和MEPS评分改善差异无统计学意义（P>0.05），Ⅲb期患者VAS评分高于其余三组，MEPS评分和运动弧低于其余三组，差异均有统计学意义（P<0.05）。 结论尽管肘关节镜技术能够让肘关节OA患者获得满意疗效，但是肘关节OA患者术后肘关节残余症状仍不可忽视，这可能与肘关节OA疾病进展有关，只有术前临床功能、影像学技术的详尽评估和手术指征的良好把握才能获得更好的临床疗效。

Analysis and prevention of postoperative residual symptoms of patients with primary osteoarthritis of the elbow after arthroscopic treatment

BackgroundSymptomatic primary elbow osteoarthritis (OA) is a common clinical disease, and the diagnosis rate of patients over 40 years old in the United States is as high as 3.5%. It is common in middle-aged men, and often seen among heavy-duty laborers such as stonemason, percussion drill user, etc., which may be related to the minor injury of humero-ulnar joint, and mainly manifest a series of symptoms such as terminal movement pain of the elbow, restricted mobility, mechanical lock, cubital tunnel syndrome, etc. At present, elbow arthroscopy has become the mainstream method for treatment of primary elbow OA due to its advantages such as wide-field vision, thorough cleaning, minimal trauma, low risk of joint stiffness, beautiful appearance, low risk of postoperative infection, and rapid recovery. The curative effects of massive domestic and foreign reports are satisfactory, which can greatly improve symptoms, mobility and function, especially the long-term clinical reports after elbow arthroscopic release surgery in which the effect has not decreased with time. Although this group of studies has achieved consistent good results, the incidence of residual symptoms is still high, which may be related to factors such as the disease progression of elbow OA, the level of arthroscopic technology, and the understanding of surgical indications. As matters stand, there are few reports on the analysis and prediction methods of residual symptoms after arthroscopy. There are many uncertain factors in the prediction of postoperative curative effect, which cannot guide and formulate individualized treatment plans. ObjectiveTo explore the postoperative residual symptoms of patients with primary osteoarthritis of the elbow after arthroscopic treatment and the precautionary measures. MethodsFrom January 2016 to September 2018, 28 patients with primary osteoarthritis of the elbow who were admitted into our hospital underwent arthroscopic debridement and release, and their data were retrospectively analyzed. There were 26 males and 2 females, and the mean age was 51.6 years (33-74 years) . According to the symptoms of elbow joints and the results of CT angiography, the elbow OA were divided into four stages, and there were 4 cases of Stage Ⅰ, 7 cases of Stage Ⅱ, 11 cases of Stage Ⅲa, 6 cases of Stage Ⅲb and no case of Stage Ⅳ. There were 10 cases combined with ulnar neuritis. The visual analogue scale (VAS) , motion arc and Mayo elbow performance score (MEPS) were used to evaluate the postoperative function of elbow joint. The rank sum test was used to compare the data between groups with significance level α=0.05. ResultsAll patients were followed up for 6-23 months with an average of 12.5 months. At the final follow-up, the satisfaction was 88.9%, and 62% of the patients returned to their previous work. Postoperative residual symptoms were found in 78.6% (22/28 cases) of those patients, including limited activity (11 cases, 39.3%) , pain (6 cases, 21.4%) , fatigue (14 cases, 50%) , soreness (14 cases, 50%) , clicking (2 cases, 7.1%) , and numbness (3 cases, 10.7%) . The incidence of residual symptoms increased with the staging progress of elbow osteoarthritis. At the final follow-up, there were no significant differences in VAS, motion arc or MEPS improvement between groups (P>0.05) . However, the mean VAS score of patients in Stage Ⅲb was higher than that in the other three groups, and the mean MEPS score and motion arc were lower than those in other three groups (P<0.05) . ConclusionsAlthough patients with primary osteoarthritis of the elbow can obtain satisfactory results from arthroscopic debridement and release, the postoperative residual symptoms must not be overlooked, which are possibly related to disease progression. Only careful preoperative assessment of clinical function and imaging examination and strict control of surgical indications can provide better results.