关节镜下肘关节游离体取出术

Arthroscopic removal of loose bodies of elbow

目的探讨关节镜在肘关节游离体治疗中的作用。方法2005年5月～2007年12月,对12例患者施行肘关节镜下游离体取出术,患者取俯卧位臂丛神经阻滞麻醉下,经中外侧(软点)、近端前外侧、近端前内侧、后正中等入路,行肘关节探查、清理及游离体取出术。结果术后患者伤口均I期愈合,12例获得随访6～37个月,平均16.5个月。术后10例(83.3%)肘疼痛消失或仅有轻微疼痛,2例(16.7%)仍有中等程度疼痛。所有8例患者机械阻挡症状均消失。随访时肘关节屈伸活动度从术前的(95±15)°提高到术后的(120±15)°,旋转活动度从术前的(110±10)°提高到术后的(130±10)°。按改良HSS肘关节评分标准,优11个肘、良1个肘。术后并发症:1例桡神经浅支暂时性麻痹和1例肘游离体残留。结论肘关节镜是治疗肘关节游离体的有效方法,可以明显缓解肘关节疼痛,改善关节活动范围,损伤小、恢复快。

[Objective] To explore the effect of arthroscopic removal of loose bodies of the elbow. [Methods] 12 patients were treated with arthroscopic removal of loose bodies. The patients positioned prone under brachial plexus anesthesia, midlateral （soft spot）, proximal anterolateral, proximal anteromedial and straight posterior portals were given to explore and debride elbow joint and remove loose bodies. [Results] All the patients achieved healing by the first intention. 12 cases were followed up for 6 to 37 months （mean 16.5 months）. 10 elbows （83.3%） were not painful or were only mildly painful and two （16.7%） were moderately painful. Mechanical symptoms disappeared in all the 8 patients. The range of motion in the flexion-extension arc was improved from （95±15）° preoperatively to （120±15）° at the time of follow up, the range in the supination-pronation are from （110±10）° to （130±10）°. According to the modified HSS elbow scoring system, the result was excellent for 11 elbows, good for 1. The complications of surgery included one transient superficial radial nerve palsy and one residue loose bodies. [Conclusion] Elbow arthroscopy is an effective tool for the management of loose body of the elbow. It can yield satisfactory pain relief, significant increase in the range of motion, minor trauma and quick recovery.