关节镜下增加软点旁辅助入路治疗肘关节僵硬

Arthroscopic treatment of elbow stiffness using an additional auxiliary soft-point portal

目的探讨关节镜下增加软点旁辅助入路治疗肘关节僵硬的疗效。方法回顾性分析2016年1月至2017年6月南昌大学第二附属医院骨科采取肘关节镜下治疗20例肘关节僵硬患者资料，男13例，女7例；年龄18～46岁，平均30．8岁。肘关节僵硬时间6～14个月（平均8．4个月）。排除手术禁忌证后予以肘关节镜下松解。术后即刻予以镇痛及分期康复锻炼。末次随访时采取美国特种外科医院（Hss）肘关节评分及Mayo评分系统进行疗效评估。结果20例患者术后均获随访，随访时间4～15个月（平均8．9个月）。肘关节最大屈曲活动度、最大伸直活动度、总屈伸活动范围术前分别为62．3°±21．4°、30．4°±13．6°、32．5°±22．4°，末次随访时改善为112．6°±23．4°、15．3°±10．4°、98．4°±15．3°，以上项目术前与末次随访时比较差异均有统计学意义（P〈0．05）。末次随访时HSS肘关节评分：优13例，良7例，优良率100％；Mayo评分由术前（64．1±12．8）分改善为术后（85．6±7．4）分，差异有统计学意义（P〈0．05）。结论关节镜下增加软点旁辅助人路治疗肘关节僵硬可便于后侧室的显露与操作，简化手术过程，获得良好疗效，是治疗肘关节僵硬的有效手术方式。

Objective To investigate the feasibility of adding an auxiliary soft-point portal for the arthroscopic treatment of stiff elbow. Methods From January 2016 to August 2017, 20 patients with stiff elbow were treated at Department of Orthopaedic Surgery, The Second Affiliated Hospital to Nanchang University. They were 13 males and 7 females, with a mean age of 30. 8 years （from 18 to 46 years） . Their elbow stiffness time averaged 8.4 months （from 6 to 14 months）. Their stiff elbow was released by elbow arthroscopy after their surgical contraindications were controlled. In addition to conventional portals, an auxiliary soft-point portal was used. Analgesia was conducted postoperatively and staged rehabilitation encouraged immediately after operation. The therapeutic effects were evaluated using Hospital for Special Surgery （HSS） elbow score and the Mayo scoring system at final follow-ups. Results The 20 patients were followed up for an average time of 8.9 months （from 4 to 15 months） . Their preoperative maximum elbow flexion （62.3°±21.4°）, maximum elbow extension （30. 4°± 13.6°） and total range of elbow motion （32.5°± 22. 4°） were significantly improved to 112.6°± 23.4°, 15.3°± 10. 4° and 98.4° ± 15.3°, respectively, at final follow-ups （ P 〈0. 05 ）. According to their HSS elbow scores, 13 cases were excellent and 7 good, yielding an excellent to good rate of 100% ; their preoperative Mayo scores （64. 1 ± 12. 8） were significantly improved to 85.6± 7.4 points at final follow-ups （ P 〈 0.05）. Conclusion Addition of an auxiliary soft-point portal in the arthroscopic treatment of elbow stiffness can simplify operative maneuver and shorten operation time, leading to fine curative efficacy.