肘关节叉状成形术重建肘关节功能的疗效分析

Evaluation of the clinical result of elbow joint functional reconstruction with fork-like arthroplasty

[目的]探讨肘关节叉状成形术治疗肘关节疾病的手术技术及临床疗效.[方法]自1973～2002年：106例肘关节疾病患者进行肘关节叉状成形术,获得随访53例56肘,男16肘,女40肘,其中类风湿关节炎39肘,结核9肘,骨关节炎4肘,色素沉着绒毛结节性滑膜炎4肘,平均病程（11.36±5.30）年（6～30年）,手术时平均年龄（39.43±11.01）岁（18～62岁）.手术指征为严重疼痛、关节僵硬或畸形.手术采用肘后正中纵切口或S形切口.游离显露尺神经,并加以保护,切除后关节囊、滑膜及病变组织.先于桡骨颈部切除桡骨小头,再切除部分鹰嘴突和冠状突,扩大鹰嘴突的滑车轨迹.凿除肱骨滑车和肱骨小头,保留肱骨内外上髁,肱骨下端呈叉状.用2枚细骨圆针交叉穿过尺骨鹰嘴,再进入肱骨下端行内固定,并使两者之间保留1～1.5 cm的空隙.术后平均住院14 d,随访平均（12.63±6.47）年（4～34年）.以HSS肘关节评分标准进行临床疗效评价.[结果]随访时肘关节屈曲畸形全部消失,关节屈伸活动度由术前（13.66±5.30）.增加到术后（91.07±12.01）.（P＜0.05）.HSS评分：术前（25.71±11.30）分,术后（84.00±7.97）分,差别有显著性（P＜0.05）,其中优15肘（26.9%）、良24肘（42.8%）、可13肘（23.2%）、差4肘（7.1%）,优良率69.7%.35肘无疼痛,21肘轻度疼痛.各病种间差别无显著性（P＞0.05）.[结论]肘关节叉状成形术是治疗肘关节疾病的有效方法.

[ Objective] To evaluate the efiqcacy of the elbow fork-like arthroplasty and discuss its operative technique in patients with elbow joint desease. [ Method] From 1973 to March 2002, 106 patients with elbow joint deseases were admitted and underwent elbow fork-like arthroplasty, of which 56 elbows in 53 patients （ 16 males, dO females） were followed up including rheumatoid arthritis in 39 elbows, tuberculosis 9 elbows, osteoarthritis d elbows and pigmented villonodular synovitis d wlbows with course of diseases （ 11.36 ± 5.30） years （ ranged, 6 - 30 years）. Each diseased joint was treated with elbow fork- like arthroplasty. The mean age of patients at time of surgery was （39. 43 ± 10. 01 ） years （ ranged, 16 - 62 years）. The technique of operation was described in detail. The mean duration of postoperative hospitalization stay was ld days, and the average follow-up time was 12. 63 years （ranged, 4 - 34 years）. The clinical results were evaluated by HSS elbow scoring system. [ Result] At final examination, the flexion deformity was all corrected with mean arc of flexion-extension motion improvement from （13.66° ± 5. 30° ） preoperatively to （91.07° ±12. 01°） postoperatively. The average HSS elbow score improved from （25.71 ± 11.30） points to （ 84.09 ± 7.97 ） points with an excellent score in 15 elbows （ 26.9% ）, good in 24 elbows （42. 8% ）, fair 13 elbows （23.2%）, and poor 4 elbows （7. 1% ）, giving an overall good and excellent results 69.7% . Thirty-five elbows had no pain while 21 elbows had mild pain, and there was no significant difference between the effects of different deseases （P 〉 0. 05 ）. [ Conclusion] Elbow with fork-like arthroplasty gives good and excellent outcomes in most elbows with different diseases and can provide satisfactory improvement in elbow function for deseased elbows.