肘关节松解术治疗儿童创伤后肘关节僵硬17例回顾分析

A retrospective analysis of open release surgical treatment for post-traumatic elbow stiffness in 17 children

目的回顾分析17例资料完整的14岁以下儿童创伤后肘僵硬患者施行了肘关节松解术疗效,探索肘关节松解术对于儿童创伤后肘关节僵硬的适应证、并发症发生情况。方法对21例14岁以下儿童创伤后肘僵硬患者施行了肘关节松解术,17例有完整随访资料。术前伸肘受限平均42.6°（0-80）°;屈肘平均74.1°（30-110）°,屈伸活动度平均31.4°（0-85）°。前臂旋转均没有受限。术前Mayo评分平均59.7（55-75）分。松解手术距伤后或首次术后平均18.4（8-44）个月。手术时采用臂丛阻滞麻醉,并留置臂丛阻滞的导管作术后镇痛使用。手术主要采用内外侧联合入路,尽量完整切除前后方关节囊,切除影响活动的异位骨化,尽量保留外侧尺骨副韧带及内侧副韧带前束,以保持肘关节的稳定性。如术中松解完成后,肘部有不稳定或半脱位趋势,则使用铰链式可活动外固定架。术后第1天即开始被动练习肘关节屈伸及前臂旋转活动。结果平均随访25.1（7-41）个月。最终随访时,患肢肘关节伸直受限平均为16.5°（0-40）°,肘关节屈曲平均为115.3°（60-130）°;肘关节屈曲活动度平均为98.8°（20-120）°,较术前平均改善67.4°。前臂旋转活动基本同健侧。Mayo Elbow Performance Score（MEPS）评分平均为87.5（55-95）分,根据≥90分为优、75-89分为良、60-74分为可及〈60分为差,本组17例,优10例、良6例、差1例,优良率94.1%。结论严格掌握适应证,肘关节松解术能够对儿童肘关节创伤后僵硬起到良好的治疗效果。

Objective Few reports of surgical treatment of post-traumatic elbow stiffness can be found in literatur. This study aimed to analyze a consecutive case series of post-traumatic elbow stiffness only in children younger than 14 years old to explore indication, surgical technique, rehabilitation, outcome and complications. Method At a mean follow-up of 25.1 months（ range, 7- 41 months）, 17 patients with post-traumatic elbow stiffness after open release treatment were evaluated. Pre-operatively, the average flexion was 74.1°（ range, 30°- 110°）, the average limitation of extension was 42.6°（ rang, 0° to 80°）, the average flexion-extension range of motion was 74.1°（ range, 30°- 110°）. The average ‘Mayo Elbow Performance Score＇（ MEPS） was 59.7 points（ range, 55 to 75 points）. Most operations were through combined approach of both lateral and medial side. Intraoperatively, we tried our best to preserve the lateral ulnar collateral ligament（ LUCL） and anterior bundle of medial collateral ligament, which are very important to the stability of the elbow. If the elbow was not stable enough intraoperatively, we applied hinged external fixator to lateral side of the elbow. Rehabilitation began on day 1 postoperatively. Results No patient complained of pain. They had an average of 115.3°（ rang, 60° to 130°） of flexion of elbow and 16.5.°（ range 0° to 40°） to full extension.） °, The average flexion-extension rang of motion was 115.3°（ range, 60°- 130°）. The average MEPS was 87.5 points（ range, 55 to 95 points）. Conclusion On appropriate indication, well performed open release treatment of the elbow can achieve good result in treating post-traumatic elbow stiffness of children.