肘关节牵伸成形术治疗外伤后屈肘挛缩畸形(附3例报告)

Treatment of post-traumatic elbow joint flexion contracture by elbow joint distraction arthroplasty

[目的]探讨肘关节牵伸成形术治疗外伤后屈肘挛缩畸形的方法与效果。[方法]参考伊里扎洛夫技术研制了环状弹性肘关节牵伸器，2003年3月～2005年7月治疗肘关节屈曲挛缩畸形3例，男1例，女2例，年龄16～17岁。平均病程12年4个月，术前屈肘畸形（以肘伸直0°位计算）1例70°，2例45°。手术操作不做皮肤切口，仅是在上肢实施穿针、安装外固定关节牵伸器的过程，注意牵伸器的关节铰链对准肘关节的伸屈旋转中心。术后逐渐旋转肘关节前的螺纹牵伸杆，使其产生持续的牵伸力，缓慢矫正屈肘挛缩畸形，在牵伸矫正过程中，定期x线检查肘关节的位置。[结果]3例病人术后牵伸平均32d，肘关节最终伸直到0°～10°位，平均矫正屈肘挛缩45°，肘关节屈伸运动弧从术前75°增加到115°，外观与功能皆达到满意结果。[结论]肘关节微创牵伸成形术可有效的矫正肘关节屈曲挛缩畸形，改善肘关节功能。

[ Objective] To explore the method and effect of elbow joint distraction arthroplasty in the treatment of post-traumatic elbow joint flexion contracture. [ Method] An Ilizarov ring distractor of elbow joint was designed. From March 2003 to July 2005, three cases of elbow joint flexion contracture aged 16 - 17 years （ one male and two females） with a flexion deformity of 70° in one case and 45° in two cases were treated. The joint distractor was applied with the wires in the upper limb and the joint hinge at the rotational centre of the elbow joint. No skin incision was made. To correct the deformity gradually, a continuous distraction force was applied by turning the nut on the distraction bar and periodic X-ray films were taken to confirm the position of the elbow joint. [ Result] The elbow joint was finally extended to 0° - 10°with an average 45°correction of flexion after an average 32 days of distraction. The range of elbow joint movement increased from pre-operative 75°to post-operative 115° [ Conclusion ] The elbow joint distraction arthroplasty is effective in the correcting of the elbow joint flexion contracture and improving of joint function.