开放手术松解结合铰链外固定支架治疗肘关节僵硬的疗效观察

Clinical efficacy observation of open surgical release combined with hinged external fixator for treatment of elbow stiffness

目的评估开放式手术松解结合铰链外固定支架治疗创伤后严重肘关节僵硬的临床疗效。方法自2016年1月至2019年1月,我们共收治15例创伤后肘关节僵硬患者,均在行开放松解后辅助铰链外固定支架治疗。术后随访比较术前、术后肘关节屈伸范围及Mayo肘关节功能评分。结果术后所有患者均获得随访,时间为4~20个月,平均12.8个月。末次随访时,肘关节主动最大伸直角度从术前的(57.1±24.2)°改善至(5.3±2.9)°,最大屈曲角度从术前的(86.6±8.9)°改善至(124.3±7.1)°,屈伸弧度从术前的(32.4±23.7)°改善至(118.0±9.2)°,差异有统计学意义(P<0.05)。Mayo评分由术前(54.2±11.6)分改善至术后(82.0±12.1)分,差异有统计学意义(P<0.05)。结论采用开放手术松解结合铰链外固定支架治疗创伤后肘关节僵硬,在彻底松解的同时又能够保证肘关节稳定及早期活动,从而达到较满意的疗效。

Objective To evaluate the clinical efficacy of open surgical release combined with hinged external fixator for treatment of severe post-traumatic elbow stiffness.Methods From January 2016 to January 2019, 15 patients with post-traumatic elbow stiffness were treated by hinged external fixator after open surgical release. At postoperative follow-up, the range of elbow flexion and extension and Mayo elbow function score were compared before and after operation.Results All the patients were follow-up for 4 to 20 months with an average of 12.8 months. At the last follow-up, the maximum active extension angle of the elbow improved from (57.1±24.2)° before operation to (5.3±2.9)° after operation, and the maximum flexion angle improved from (86.6±8.9)° to (124.3±7.1)°. The flexion and extension arc improved from (32.4±23.7)° before operation to (118.0±9.2)° after operation, which was statistically significant (P<0.05). The Mayo score was improved from 54.2±11.6 before operation to 82.0±12.1 after operation (P<0.05).Conclusion The treatment of post-traumatic elbow stiffness with open surgical release combined with hinged external fixator can ensure the stability and early movement of elbow joint at the same time of complete release, so as to achieve a satisfactory effect.