肘关节镜下清理松解治疗肘关节骨关节炎并发强直的疗效分析

Arthroscopic clearance and release for elbow osteoarthritis with ankylosis

目的探讨肘关节镜下清理松解术治疗肘关节骨关节炎并发肘关节强直的疗效。方法2013年4月至2015年3月河南省洛阳正骨医院上肢损伤科共治疗并发肘关节强直的重度肘关节骨关节炎19例,平均年龄(57±17)岁。男14例,女5例;右侧15例,左侧4例;优势侧14例,非优势侧5例;其中并发肘尺管综合征7例。行关节镜下肘关节滑膜清理,取出游离体,进行尺骨鹰嘴和鹰嘴窝,尺骨冠突、冠突窝和桡骨窝骨赘清理磨削成形,对挛缩的关节囊和侧副韧带等给予松解,并发肘尺管综合征病人予以内侧切口尺神经松解原位放置或皮下前置。采用t检验比较术前和术后肘关节视觉模拟疼痛评分(VAS评分)、肘关节平均屈伸活动度和肘关节功能评分(Mayo肘关节功能评分)。结果术后获得随访17例,失访2例,平均随访时间(18±6)个月。16例患者肘关节疼痛和屈伸活动度均有明显改善,1例疼痛改善不明显但活动度改善明显,平均关节活动度由术前(84.2±14.1)°增加为术后(113.1±15.5)°(t=26.182,P<0.01),平均VAS评分从术前(4.9±2.1)分降为术后(1.6±0.7)分(Z=4.991,P<0.01),Mayo肘关节功能评分从(56.8±13.6)分改善为(80.4±12.5)分(t=23.629,P<0.01),1例出现尺神经损伤症状,术后14个月随访时完全恢复,无感染、其他神经损伤等并发症,并发肘尺管综合征病人中6例感觉完全恢复正常,1例明显改善。结论关节镜下肘关节清理松解术可显著缓解疼痛、改善肘关节屈伸活动度与术后功能,并发肘尺管综合征可以通过相应松解有效处理。

Objective To evaluate the efficacy of arthroscopic clearance and release for elbow osteoarthritis with ankylosis. Methods From April 2012 to March 2015,19 patients（ 14 males,five females） suffered elbow osteoarthritis with ankylosis were treated with arthroscopic clearance and release.The mean age was（ 57 ± 17） years. There were 15 right elbows and four left cases with 14 dominant side elbows and five non-dominant-side elbows. Seven patients had concomitant cubital tunnel syndrome.Debridement of synovium and plasty of the osteophyte of olecranon and its fossa,coronoid tip and its fossa as well as radial fossa were performed; loosening bodies were removed and the contracture of capsule and collateral ligaments was released. The patients with cubital tunnel syndrome adopted a medial incision and the ulnar nerves were released with or without subcutaneous anterior transposition. Visual analog scale（ VAS） pain score was used to evaluated pain; pre-and post-operative ranges of motion（ ROM） were measured; pre-and post-operation elbow functions were evaluated by Mayo elbow performance score（ MEPS） and compared by t test. Results Two patients were lost and the other 17 patients were followed up for（ 18 ± 6） months. All the patients got both improved ROM and pain relief but one patient only got improved ROM. The mean ROM improved from（ 84. 2 ± 14. 1） ° to（ 113. 1 ± 15. 5） °（ t = 26. 182,P〈0. 01） and VAS scores for pain decreased from（ 4. 9 ± 2. 1） to（ 1. 6 ± 0. 7） after the operation（ Z =4. 991,P〈0. 01）; MEPS improved from（ 56. 8 ± 13. 6） to（ 80. 4 ± 12. 5）（ t = 23. 629,P〈0. 01）. The ulnar nerve injury occured in one patient and recovered at 14 months postoperative follow-up; no complication such as infection or other nerve injury was found. As for the patients with cubital tunnel syndrome,paresthesia was improved significantly in one patient and eliminated in six patients. Conclusion Arthroscopic debridement and arthrolysis for elbow osteoarthritis with ankylosis provides satisfactory pain relief,improvement of elbow motion,and good functional outcome; the combining cubital tunnel syndrome could be managed with adhesiolysis.