开放肘关节松解术联合Ilizarov环式外固定治疗重度或极重度创伤性肘关节僵硬的临床疗效

Clinical efficacy of open elbow joint release combined with Ilizarov ring external fixation for treatment of severe or extremely severe traumatic elbow stiffness

目的探讨开放肘关节松解术联合Ilizarov环式外固定治疗重度或极重度创伤性肘关节僵硬(TES)的临床疗效。方法回顾性分析18例重度或极重度TES患者的临床资料。所有的患者均采用开放肘关节松解术联合Ilizarov环式外固定辅助牵伸进行治疗。术后随访12个月,比较手术前后患者的患侧肘关节屈伸及旋转活动度、Mayo肘关节功能评分(MEPS),并记录随访期间患者不良反应发生情况。结果术后12个月时,患者的患侧肘关节屈曲及旋转活动度、MEPS评分均高于术前(均P<0.05)。随访期间有1例患者出现小鱼际肌及小指皮肤麻木、疼痛,有6例患者存在不同程度的钉道口感染,经对症治疗后均可缓解,无其他严重不良反应发生。结论采用开放肘关节松解术联合Ilizarov环式外固定治疗能有效地改善重度或极重度TES患者肘关节屈伸、旋转功能,且并发症少,疗效可靠。

Objective To explore the clinical efficacy of open elbow joint release combined with Ilizarov ring external fixation for the treatment of severe or extremely severe traumatic elbow stiffness(TES).Methods The clinical data of 18 patients with severe or extremely severe TES were analyzed retrospectively.All patients were treated with open elbow release combined with adjuvant traction with Ilizarov ring external fixation.The patients were followed up for 12 months after operation,the flexion,extension and rotation range of motion(ROM)and Mayo elbow function score(MEPS)of the affected elbow joint before and after operation were compared,and the incidence of adverse reactions was recorded during the follow-up period.Results Twelve months after operation,the ROM of flexion and rotation and MEPS scores of the affected elbow joint were higher than those before operation(all P<0.05).During the follow-up period,one patient had numbness and pain in the hypothenar muscle and pinkie skin,and six patients had varying degrees of nail crossing infection.After symptomatic treatment,they obtained symptom remission,and no other serious adverse reactions occurred.Conclusion Open elbow joint release combined with Ilizarov ring external fixation in the treatment of severe or extremely severe TES patients can effectively improve the flexion and extension and rotation function of the elbow joint with few complications and reliable efficacy.