关节松解术后短期屈曲位固定结合早期康复治疗肘关节僵硬

The arthrolysis release combined with postoperative short-term flexion immobilization and early rehabilitation training in the treatment of contracture ankylosis of elbow

目的探讨关节松解术结合短期屈曲位固定与早期康复训练治疗肘关节僵硬的临床疗效。方法自2006年6月至2009年1月对15例肘关节僵硬的患者实施关节松解术,术后将肘关节屈曲位固定48-72h,同时积极进行早期康复治疗。结果所有15例患者术后随访48个月。在患肘关节平均活动范围方面,术后3个月优于术前(P<0.01),术后24个月优于术前(P<0.01),术后48个月优于术前(P<0.01),差异均有非常显著意义;术后48个月优于术后24个月(P<0.05),差异有显著意义。无1例患者发生伤口感染、关节不稳、异位骨化较术前明显增加等不良并发症。据Mayo肘关节功能评分标准,术前关节功能良1例,中3例,差11例;术后3个月关节功能优良率为80%,术后24个月关节功能优良率为93.3%,术后48个月关节功能优良率为100%。结论关节松解术后短期屈曲位固定结合早期康复治疗肘关节僵硬效果显著,手术安全,后期随访治疗效果稳定,该方法不失为一种治疗肘关节僵硬的较好方法 。

Objective To evaluate the effects of the arthrolysis combined with postoperative short-term flexion immobilization and early rehabilitation training in the treatment of contracture ankylosis of elbow. Methods From June 2006 to January 2009, 15 patients underwent arthrolysis. The flexion positions were fixed 48-72 hours postoperatively meanwhile early rehabilitation was implemented. Results All 15 patients were followed up for 48 months. 3 months postoperatively, average range of motion of the affected elbow was better than preoperatively （P〈0.01）. 24 months preoperatively was better than preoperatively （P〈0.01）. 48 months preoperatively was better than preoperatively （P〈0.01）. The difference had remarkable significance. 48 months preoperatively was better than 24 months preoperatively （P〈0.05）. The difference was significant. No complications such as infection, joint instability or bad ectopic ossification was discovered. According to Mayo elbow functional score standard, preoperative joint function was good in 1 case, fair in 3 cases, and bad in 11 cases. The excellent and good rate of joint function was 80% 3 months postoperatively, 93.3% 24 months postoperatively and 100% 48 months postoperatively. Conclusions The arthrolysis combined with postoperative short-term flexion immobilization and early rehabilitation has stable treatment effect in the later follow-up. As a result, this can be regarded as a safe and proper method in the treatment of contracture ankylosis of elbow.