创伤后肘关节功能障碍的手术治疗及影响疗效的相关因素分析

Analysis of surgical treatment of elbow joint dysfunction after trauma and related factors influencing the curative effect

目的评价个性化手术治疗创伤后肘关节功能障碍的疗效,并且分析影响疗效的相关因素。方法回顾性分析自2014-05—2015-03采用手术治疗的76例创伤后肘关节功能障碍。术后1年采用肘关节功能Mayo评分评定疗效,按结果分为关节功能优良组和关节功能不良组,采用多因素Logistic回归分析年龄、异位骨化、关节僵硬时间、手术次数、术后开始功能锻炼时间对疗效的影响。结果 76例均随访满1年。术后1年肘关节功能操练活动范围(118.6±21.2)°,前臂旋转范围(141.5±20.8)°,较术前明显增加,差异有统计学意义(P<0.05)。术后1年采用肘关节功能Mayo评分评定疗效:优42例,良24例,可6例,差4例,优良率86.8%。单因素分析显示,年龄、异位骨化、关节僵硬时间、手术次数、术后开始功能锻炼时间均会对术后疗效产生影响。多因素Logistic回归分析结果显示,异位骨化、关节僵硬时间是影响术后疗效的独立因素。结论个性化手术方案治疗创伤后肘关节功能障碍可获得良好疗效,但术前需注意对出现异位骨化及关节僵硬时间较长的患者加以重视,以确保患者获得最佳疗效。

Objective To evaluate the efficacy of personalized surgery in the treatment of postoperative traumatic elbow dysfunction, and analyze the relevant factors affecting the efficacy. Methods Seventy-six cases of postoperative traumatic elbow joint dysfunction from May 2014 to March 2015 in hospital were retrospectively analyzed. One year after surgery the efficacy was assessed with elbow function Mayo score, and multivariate Logistic regression was used to analyze the effect of age, heterotopic ossification, joint stiffness time, operation frequency and postoperative functional exercise time on the curative effect. Results Seventy six patients were followed up for 1 year. One year after surgery elbow joint function range was （118.6＋21.2）~, forearm rotation range （141.5＋20.8）~, significantly increased compared with that before operation, the difference was statistically significant（P 〈0.05）. One year after surgery the efficacy was assessed with elbow function Mayo score： ＇i^excellent in 42 cases, good in 24 cases, dependable in 6 cases, poor in 4 cases, excellent and good rate of 86.8%. Univariate hnalysis showed that age, heterotopic ossification, joint stiffness time, operation frequency, postoperative functional exercise time had impact on postoperative efficacy. Multivariate Logistic regression analysis showed that heterotopic ossification and joint stiffness were independent factors influencing postoperative efficacy. Conclusion Personalized surgical regimen for the treatment of post-traumatic elbow dysfunction is effective, but before surgery attention should be paid to the patients with heterotopic ossification and longer joint stiffness to ensure that patients get the best results.