摘要
目的分析手术松解治疗创伤后肘关节僵硬患者的疗效,并探讨创伤后肘关节僵硬的治疗方法。方法本组共12例患者,其中男性9例,女性3例;左侧、右侧各6例。患者平均年龄32岁(16~47岁)。原始损伤单纯骨折7例,单纯脱位1例,骨折合并脱位2例,单纯软组织损伤2例。患者伤后以石膏或颈腕吊带固定时间平均3.3周(0~8周)。患者受伤至本次手术时间平均6.4个月(1-14个月)。术前平均活动度为33.8°(0°~80°)。本组患者术前3例前臂旋转受限。4例患者采用后侧入路,6例患者采用内、外侧联合入路,2例采用单纯内侧入路。去除影响肘关节活动的因素,部分患者行上尺桡关节松解。术中尽量达到肘屈伸0°~140°,前臂旋前80°,旋后90°。非常规行尺神经前移。术后第1天开始主动及主动辅助肘及前臂功能锻炼。口服吲哚美辛以预防异位骨化。术前Mayo肘关节功能评分平均70.4分(50~90分)。结果所有患者均获随访,术后随访14~18个月,平均15,8个月,术后平均活动度为120.8°(100°~140°),9例患者(75%)恢复了肘关节屈伸30°~130°的功能弧度。10例患者伸肘受限10°以下,4例患者可达伸肘0°。3例术前前臂旋转受限患者术后旋转功能改善。术后Mayo肘关节功能评分平均98.8分(85~100分)。患者皆无异位骨化迹象。结论术前审慎评估患者肘关节功能情况,术中细致松解,术后早期主动及主动辅助功能锻炼,可以取得良好的临床效果。
Objective To report the method and result of open arthrolysis of patients who suffered from severe post-traumatic elbow stiffness. Methods Of the 12 patients, there were 9 male and 3 female, average age of 32 years old (16-47 years). Primary injury included 7 simple fractures, 1 simple dislocation, 2 fracture dislocations and 2 soft tissue injury. The averaged time of immobilization after injury was 3.3 weeks (0-8 weeks). The averaged time between injury and open arthrolysis was 6. 4 months ( 1-14 months). Before open arthrolysis, the mean arc of total motion was 33.8° (0°-80°). Three patients suffered from forearm rotation deficiency. Posterior approach was used for 4 patients, medial approach for 2 patients and both medial and lateral approach for 6 patients, tissues were resected, which hindered the motion of the elbow and perform proximal radioulnar joint arthrolysis for some patients. After arthrolysis, the arc of elbow motion could reach 0°-140°, and for the patients who suffered from forearm rotation deficiency, pronation 80° and supination 90° were gotten. Ulnar nerve transposition was not a routine. The patients began active and active-assisted elbow and forearm movement the first day after operation. Indomethacin was taken the first day after open arthrolysis routinely. Results Twelve patients were followed up for 14-18 months (averaged 15. 8 months). At the latest follow-up, the mean arc of total motion was 120. 8° (100°-140°). Nine patients recovered the functional arc of 30°-130°, and 10 patients extended to less than 10°, and 4 patients could extend to 0°. As for the 3 patients who suffered forearm rotation deficiency, the forearm rotation improved. The mean Mayo elbow performance score was 70. 4 (50-90) before open arthrolysis, and 98. 8(85-100 ) after open arthrolysis. No patient was found to have signs of heterotopic ossification. Conclusions For the treatment of post-traumatic stiff elbow, with careful open arthrolysis and early active and active-assisted exercise we can get good results.
出处
《中华外科杂志》
CAS
CSCD
北大核心
2008年第20期1568-1571,共4页
Chinese Journal of Surgery
关键词
肘关节
创伤和损伤
功能恢复
外科手术
Elbow joint
Wounds and injuries
Recovery of function
Surgical procedures,operative