内外侧肌群-韧带复合体彻底剥离松解治疗创伤后异位骨化所致肘关节僵硬

Results of open arthrolysis by totally dissection of collateral ligament-muscular complex in treatment of post-traumatic elbow stiffness due to ectopic ossification

目的研究评价内外侧肌群-韧带复合体彻底剥离松解术治疗创伤后异位骨化所致肘关节僵硬的临床效果。方法回顾性分析我院2003年3月至2007年12月采用肱骨内外髁附着肌群-韧带复合体彻底剥离松解术治疗的15例创伤后异位骨化所致肘关节僵硬患者,根据Morrey分类和Mayo评分评价手术前后肘关节功能。结果 Morrey分类显示术前肘关节僵硬情况非常严重(活动范围<30°)者10例,严重(活动范围30°～60°)者5例。受伤至肘关节松解时间为4个月～6年,平均12.7个月。术后15例切口均Ⅰ期愈合,X线片检查显示骨性愈合。术后主动屈伸活动度由术前平均30.4°±25.7°提高至术后平均111.7°±32.0°,肘关节功能评分由术前平均33.1±2.6分提高至术后平均87.1±2.5分,差异均有统计学意义(P<0.05)。术后肘关节功能优10例,良3例,中1例,差1例,优良率为86.67%。结论内外侧肌群-韧带复合体彻底剥离治疗能够有效改善创伤后异位骨化所致肘关节僵硬,并保证关节的侧方稳定性。

Objective To assess the outcome in improvement of the range of motion of post-traumatic elbow stiffness due to ectopic ossification after open arthrolysis. Methods A retrospective study was conducted in 15 patients of post-traumatic elbow stiffness due to ectopic ossification. All the cases （from March 2003 to December 2007） received open arthrolysis by totally dissection of collateral ligament-muscular complex, the preoperative and postoperative function of elbow were both evaluated by Morrey classification and Mayo function score. Results According to Morrey classification, 10 cases were extremely serious （less than 30° flexion extension arc） and 5 cases were serious （30°-60° flexion-extension arc）. The time to arthrolysis after injury ranged from 4 months to 6 years （average, 12.7 months）. At the final follow up, the average arc of flexion-extension was 111.7° ± 32.0° （mean improvement of 81.3~relative to the preoperative range, P〈0.05）, the average Mayo function score was 87. 1 ± 2. 5 （mean improvement of 54. 0 relative to preoperative score, P〈0. 05）, with 10 excellent, 3 good, 1 fair and 1 poor results. Conclusion In case of post-traumatic elbow stiffness due to ectopic, ossification open arthrolysis by totally dissection of collateral ligamentmuscular complex yields good result.