全关节镜松解术治疗肘关节僵硬的影响因素分析

Analysis of the Influencing Factors of Total Arthroscopic Arthrolysis for Elbow Joint Stiffness

目的对比研究不同因素对肘关节僵硬全关节镜松解治疗效果的影响。方法对129例肘关节僵硬患者行全关节镜松解治疗。全关节镜下清理肘关节尺骨冠突、鹰嘴、肱骨冠突窝、鹰嘴窝及内外侧间沟等部位的瘢痕及骨赘,术毕施以手法松解。术后常规冰敷1周,术后1 d即在可调支具保护下进行屈伸锻炼。术后平均随访18.4月,分别于术前及术后6个月对患者进行肘关节活动度(ROM)测定,分析比较不同因素对手术效果的影响。结果所有病例ROM均获改善,平均改善(70.36±11.26)°。其中,骨性关节炎的松解效果较其他病因的治疗效果稍差(P<0.05)。对肱骨远端骨折所致僵硬的疗效差于尺桡骨骨折所致僵硬(P<0.05)。另外,年龄和病程对手术效果也具有影响(均P<0.05)。结论在病因因素中,骨性关节炎引起的肘关节僵硬,关节镜治疗效果相对不佳,肱骨远端骨折较尺桡骨骨折效果差,老年患者及病程长者,手术效果次于年轻和病程较短者。

Objective The purpose of this study was to investigate and compare the effects of different factors on the treatment of elbow joint stiffness with total arthroscopic arthrolysis.Methods A total of 129 patients with elbow stiffness treated with total arthroscopic lysis were followed up for a mean of 18.4 months.The patients were examined by ROM before and 6 months after surgery.The effects of different factors on the surgical outcome were analyzed.Surgical method was as follows:the scars and osteophyte in elbow joint(including ulnar coronoid process,olecranon,humeral coronal fossa,olecranon fossa and medial and lateral groove)were cleaned under microscope.After operation,ice compress was applied for 1 week,the flexion and extension exercise was performed under the protection of the adjustable brace 1 day after the operation.Results The ROM of this group was improved,with an average of(70.36±11.26)°.Among them,effect of arthrolysis was the worst in osteoarthritis(P<0.05).It was worse in distal humerus fracture than in ulnar and radius fracture(P<0.05).In addition,age and duration of the disease also had an effect on the surgical outcome(P<0.05).Conclusion Among the etiology factors,the arthroscopic treatment of elbow joint stiffness caused by osteoarthritis is relatively inferior.The method is less effective for the distal humerus fracture than for the ulna and radius fracture.The elderly patients and the patients with a longer duration have worse surgical outcomes than those of younger age and shorter duration.