关节镜下清理术治疗创伤后肘关节僵硬的临床研究

Efficacy of arthroscopic debridement for treatment of post-traumatic elbow stiffness

目的评估关节镜下肘关节清理术治疗创伤后肘关节僵硬的临床疗效。方法回顾性分析2012年1月至2016年12月上海中冶医院收治的42例创伤后肘关节僵硬患者,全部给予关节镜下清理术,术后第1天即在疼痛控制下进行肘关节屈伸功能锻炼,比较手术前后肘关节主动活动的关节活动度(range of motion,ROM),Mayo肘关节功能评分(Mayo elbow performance score,MEPS)及疼痛视觉模拟评分(visual analogue scale,VAS)。结果全部患者获得随访,分别于术后3、6、12个月进行随访。术后肘关节ROM较术前有明显改善,差异有统计学意义(P<0.05)。术后3~6个月改善较为明显,6~12个月改善幅度降低。在MEPS评分方面从术前的(69.5±15.5)分增加至末次随访的(90.4±22.4)分,平均改善了20.9分(P<0.001)。术后MEPS评分结果为优22例,良17例,中3例,优良率达92.86%。术后较术前VAS均明显降低(P<0.05)。结论关节镜下清理术是治疗创伤后肘关节僵硬一个很好的治疗方式,创伤小,疼痛轻,有利于术后早期功能锻炼,能够改善肘关节功能。

Background With over 5%of morbidity,elbow stiffness is a common and difficult complication after elbow trauma or surgery,which can severely interfere with the daily activities and life quality of patient.The post-traumatic elbow stiffness may be caused by intraarticular or extra-articular factors.The common intra-articular factors include osteophytosis,osteochondritis,synovitis,joint asymmetry and loose bodies,while the common extra-articular factors include heterotopic ossification,joint capsule contracture,ligament injury,fasciitis and skin di seases.The se f actors re sult i n j oint st iffness by a ltering no rmal e lbow mo tions.The mi xed presence of intra-articular and extra-articular factors is also common.The failure of conservative treatment is a definite indication of surgical treatment.