肘关节镜术后失败原因分析及对策

Causes and Stratagems for the Failure Cases of Elbow Arthroscopy

目的分析肘关节镜二次手术病例初次手术失败原因,总结翻修手术临床效果。方法回顾我科自2010年2月至2015年6月收治的12例肘关节镜术后失败的病例,通过术前检查及术中关节镜下所见分析首次手术失败原因,记录术中处理措施及术后临床疗效。手术操作流程采用北医三院程序及崔国庆的7分区法。结果首次手术失败原因如下:7例骨关节炎病人骨赘清理不彻底;4例类风湿性关节患者滑膜切除不充分;1例滑膜软骨瘤病人软骨瘤没有清理干净。术后肘关节屈伸活动范围较术前有显著性提高。肘关节Mayo评分从术前(53.8±14.9)分提高到末次随访的(96.3±6.8)分(P<0.05);VAS评分从术前(4.9±1.4)分改善到术后12月随访时的(0.3±0.5)分(P<0.05)。所有患者对手术效果均主观满意。结论初次肘关节镜手术失败原因主要由于关节腔内病变清理不彻底,二次手术困难较大。术前详细及完善的检查,术中按序不留遗漏的检查及操作,是肘关节镜翻修成功的关键。

Objective To evaluate the results of elbow revision arthroscopy and identify the causes of failure of the primary operation.Methods A cohort of 12 revision elbow arthroscopies recruited from February 2010 to June 2015 in our hospital were retrospectively assessed.Causes of failure of the primary operation were studied.Revision countermeasures were documented and the clinical outcomes were investigated.The debridement was done following Cui＆#39;s procedures.Results Our investigation revealed the causes of failures as follows,unthorough removement of the osteophytes in seven cases of OA;unthorough debridement of the synovium in four cases of RA;and chondroma residue in one synovial chondromatosis.The postoperative elbow flexion-extension range of motion was significantly higher comparing with the pre-operative range of motion.The Mayo elbow performance score was improved from 53.8 ± 14.9 to 96.3 ±6.8 at 12-month follow-up （P 〈 0.05）.The VAS was decreased from 4.9 ± 1.4 to 0.3 ± 0.5 （P 〈 0.05）.All patients were satisfied with the revision arthroscopy results.Conclusions Primary arthroscopy failures may result from unthorough debridement of the lesion,which results the difficulty of revision.Arthroscopy of the elbow,following specific procedure under sufficient preoperative preparation is safe and efficacious.