完全僵直的创伤后肘关节僵硬开放松解术长期疗效分析

Long-term outcomes after open arthrolysis for posttraumatic ankylosed elbows

目的探讨切开松解术联合Stryker DJDⅡ铰链式外架治疗完全僵直的创伤后肘关节僵硬的长期疗效。方法回顾性分析2011年2月至2013年6月北京积水潭医院收治的20例屈伸活动范围为0°的创伤后肘关节僵硬患者的临床资料,所有患者均行肘关节切开松解术,联合Stryker DJDⅡ铰链式外架固定。受伤至松解手术时间为6~60个月,平均(12.2±12.1)个月。其中9例采用后正中入路,11例采用内、外侧联合入路,所有患者均行尺神经松解并前移至皮下组织。术后1年及末次随访时评估肘关节活动范围并采用Mayo肘关节功能评分(Mayo elbow performance score,MEPS)评定肘关节功能,并统计术后并发症发生情况。结果20例患者铰链式外架带架时间为6~8周,平均(7.4±0.9)周。所有患者均获随访,随访时间8.0~9.8年,平均(9.1±0.6)年。与术前比较,术后1年随访时20例患者肘关节屈伸活动范围由0°改善至104.9°±22.9°(45°~135°),旋转活动范围由110.8°±79.7°(0°~180°)改善至145.8°±57.5°(0°~180°),MEPS评分由(63.3±7.7)分改善至(90.8±9.5)分,差异均有显著性(P<0.05)。术后1年随访时MEPS评分优12例,良7例,可1例,优良率为95%。上述指标的改善在末次随访时继续保持。术后发生尺神经功能障碍1例,针道轻度感染2例。结论切开松解术联合Stryker DJDⅡ铰链式外架治疗完全僵直的创伤后肘关节僵硬疗效满意且可长期保持。

Objective To retrospectively evaluate the long-term results of open arthrolysis with Stryker DJDⅡhinged external fixators which performed on 20 patients suffers from ankylosed elbows with range of motion of 0°.Method 20 completely ankylosed elbows were treated by arthrolysis and Stryker DJDⅡhinged external fixators from February 2011 to June 2013.This retrospective study included 20 patients(13 males and 7 females)with a mean age of(35.5±9.0)years(24 to 55).The mean duration of stiffness was(12.2±12.1)months(6 to 60).Eleven patients underwent arthrolysis by medial and lateral approaches,nine patients by the posterior approach.Subcutaneous anterior transposition of the ulnar nerve was performed in all patients.Result The average follow-up time was(9.1±0.6)years from 8 to 9.8 years with a mean time of external fixation of(7.4±0.9)weeks(from 6 to 8 weeks).At the first year of follow-up,The mean ROM in extension and flexion was improved from preoperative 0°(0°to 30°)to Postoperative 104.9°±22.9°(45°to 135°);The mean pronation and supination was improved from preoperative 110.8°±79.7°(0°to 180°)to Postoperative 145.8°±57.5°(0°to 180°).The Mayo elbow score improved from a mean of 63.3±7.7(40 to 75)to 90.8±9.5(70 to 100)points,and 12 had excellent,7 had good,1 had fair and none had a poor result.There were significant difference between pre-operation and post-operation in all the indexes above(P<0.05).This improvement was maintained over the mean follow-up period of 9.1 years(8 to 9.8).These patients had 3 minor postoperative complications:1 ulnar nerve symptom,2 pin-track infections.None of these complications influenced the final result clinically.Conclusion Open arthrolysis with Stryker DJDⅡhinged external fixators is effective in the treatment of posttraumatic ankylosed elbow with a low complication rate.