肘后改良S型切口手术松解配合术中手法松解治疗创伤性肘关节僵硬的临床效果

Clinical effect of surgical release plus manipulative release during operation through improved posterior elbow ‘S’ shape incision approach to treat traumatic elbow anchylosis

目的探讨肘后改良S型切口手术松解配合术中手法松解治疗创伤性肘关节僵硬的临床效果,为创伤性肘关节僵硬提供一种新的治疗方法。方法回顾性分析2008年1月～2011年1月我科收治的20例创伤性肘关节僵硬患者采用肘后改良S型切口手术松解配合术中手法松解治疗的临床资料,对肘关节术后功能恢复进行系统评价。结果随访3～24个月,平均12.4个月。患肘关节的活动范围即伸屈活动度术后较术前平均增加45°;术后平均最大伸展度为11.6°,平均最大屈曲度为108.6°。无一例发生伤口感染、皮肤坏死、术后肘关节不稳、活动性疼痛等并发症,符合美容学标准。依据Mayo肘关节功能评定标准,术前关节功能良4例,中10例,差6例;术后关节功能优15例,良3例,差2例。结论肘后改良S型切口手术松解配合术中手法松解治疗创伤性肘关节僵硬的临床效果显著,可以应对创伤性肘关节僵硬的多样性和复杂性,是一种值得推广的治疗方法。

Objective To investigate the clinical effect of surgical release plus manipulative release during operation through improved posterior elbow ＂ S＂ shape incision approach to treat traumatic elbow anehylosis and provide new treatment to traumatic elbow anchylosis. Methods Totally 20 cases of traumatic elbow anehylosis were reviewed from Jan. 2008 to Jan. 2011 from our hospital. Surgical release plus manipulative release during operation through improved posterior elbow ＂ S＂ shape incision approach was used, and systematic evaluation of elbow function was performed. Results Follow-up period ranged 3-24 months （ mean 12.4 months ）. Range of motion of elbow （flexion/extension） after operation increased 45 degree compared with the preoperative range. Average maximal extension was 11.6 degree and average maximal flexion was 108.6 degree. There were no instances of incision infection, skin necrosis, elbow instability or mobility related pain which complied with cosmetology standard. According to Mayo Elbow Performance Score system, before operation there were 4 cases of good, 10 cases of fair, and 6 cases of poor. After operation there were 15 cases of excellent,3 cases of good, and 2 cases of poor. Conclusion The clinical effect of surgical release plus manipulative release during operation through improved posterior elbow ＂ S＂ shape incision approach to treat traumatic elbow anchylosis is good and this method can response to diversity and complexity of elbow anchylosis and is deserved to be widely spreaded.