关节镜手术治疗肘关节伸直受限的临床研究

Treatment of elbow dysfunction under elbow arthroscopy

目的 探讨关节镜下手术治疗肘关节伸直受限的临床疗效.方法 2007年9月至2009年12月收治21例肘关节伸直受限患者,病程中均有慢性肘关节过伸落空损伤史,有过伸受限合并疼痛症状,平均伸直滞缺18.2°（10°～25°）.全部采用五通道入路法行关节镜探查手术,术中清理前关节腔,必要时松解前方关节囊,清除肱骨滑车骨赘,行肱骨鹰嘴窝和尺骨鹰嘴成形术.术后常规抗感染、康复训练及预防骨化性肌炎治疗.随访时对比手术前、后的肘关节活动度,并采用Mayo评分表对肘关节功能进行评价,总结术后并发症.术前Mayo评分良13例,中5例,差3例.结果 21例患者术后随访6～29个月（平均19.7个月）.21例患者肘关节功能恢复良好,过伸度均得到改善,疼痛症状消失.平均伸直滞缺2.4°（0°～5°）.术后Mayo评分优17例,良4例,中0例,差0例.未见神经并发症.结论 肘关节镜下手术具有创伤小、出血少、并发症少的特点,配合合理的康复训练,能有效改善肘关节的功能,是治疗肘关节伸直受限的有效术式.

Objective To evaluate early clinical outcome after arthroscopic treatment of elbow dysfunction. Methods From September 2007 to December 2009, 21 patients with elbow dysfunction were treated with an arthroscopic procedure. All patients had chronic history of elbow dysfunction. Extension lag was 18.2°（10°-25°）combined with pain. All patients underwent five-portals arthroscopic release and debridement. Postoperative care including anti-infectin, rehabilitation and prophylaxis of myositis ossificans were prescribed. All elbows were assessed for increase in ROM and Mayo assessment before and after surgery. Mayo score assessment： ≥ 90 points, excellent; 75-89 points, good; 60-74 points, common; 〈 60,bad. Complications were evaluated. Results At an average follow-up of 19. 7 months（6-29 months）, all patients had improvement of extension and relieve of pain. The average lag of extension was 2. 4°（0°-5°）.Pre-operative Mayo assessment： good, 13 patients; common, 5 patients; bad, 3 patients. Post-operation Mayo assessment： excellent, 17 patients; good, 4 patients; common, 0 patients; bad, 0 patient. There was no complication in this case serial Conclusions Arthroscopic surgery can minimize trauma and bleeding, and reduce complications. Combined with reasonable rehabilitation, arthroscopic surgery can improve elbow function and appears to be satisfactory management.