改良开放肘关节松解术治疗创伤后肘关节僵硬的临床疗效研究

Clinical effects of modified open elbow arthrolysis in the treatment of post-traumatic elbow stiffness

目的:研究改良开放肘关节松解术治疗创伤后肘关节僵硬的临床疗效。方法:采用回顾性研究方法分析2018年1月—2020年12月北京积水潭医院收治的120例接受改良开放肘关节松解术患者的临床数据,患者年龄(37.7±12.4)岁,年龄范围18~64岁,其中男性54例,女性66例。对比患者术前、末次随访时肘关节屈曲旋转活动范围、功能状况,包括视觉模拟评分(VAS),Mayo肘关节功能评分(MEPS),手臂、肩部和手残疾评分(DASH)。记录患者并发症及二次手术情况。正态分布的计量资料以均数±标准差(x±s)表示,组间比较采用t检验;偏态分布的计量资料以M(Q_(1),Q_(3))表示,组间比较采用秩和检验。结果:120例患者术前伸直角度为43.6°(33.8°,60.1°),屈曲角度为78.7°(59.8°,98.1°),屈伸活动范围为25.6°(0.0°,54.5°);术前旋前为51.8°(33.0°,67.0°),旋后为85.1°(65.7°,90.0°),旋转范围为136.9°(99.1°,157.5°);术后伸直角度为14.2°(7.0°,24.8°),屈曲角度为129.5°(120.0°,138.1°),屈伸范围为115.5°(94.4°,127.3°);术后旋前为65.0°(47.1°,75.0°),旋后为88.3°(78.6°,90.0°),旋转范围为151.9°(131.7°,163.4°)。术后的伸直、屈曲、屈伸范围、旋前、旋后、旋转范围均高于术前,差异均具有统计学意义(P<0.001)。120例患者的术前VAS为1.0(0.0,3.0)分,术后为0.0(0.0,1.0)分。术前MEPS为60.0(50.0,75.0)分,术后为100.0(85.0,100.0)分。术前DASH为37.5(20.1,51.3)分,术后为7.9(3.3,13.3)分。术后的VAS、MEPS、DASH均较术前有显著改善,手术前后相比差异均具有统计学意义(P<0.001)。术后残留尺神经症状18例,异位骨化复发42例,血肿3例。结论:改良开放肘关节松解术是一种治疗创伤后肘关节僵硬安全有效的手术方式。可显著改善患者功能,降低肘关节不稳定的发生,避免使用外固定架,降低患者花费。

Objective:To study the clinical efficacy of modified open elbow arthrolysis in the treatment of traumatic elbow stiffness.Methods:A retrospective analysis was performed on 120 patients who underwent modified open elbow arthrolysis in Beijing Jishuitan Hospital from January 2018 to December 2020.The age of the included patients was(37.7±12.4)years(ranged 18-64 years),including 54 males and 66 females.The medical records were reviewed,the range of motion(ROM)and functional status of the patients before operation and at the last follow-up were compared including visual analogue scale(VAS),Mayo elbow performance score(MEPS),Disabilities of the arm,shoulder and hand(DASH)score.Complications and secondary operations were also recorded.Measurement data with normal distribution were presented as mean±standard deviation(x±s)and comparison between groups was conducted using the t-test;Measurement data of skewed distribution were expressed as M(Q_(1),Q_(3)),and Rank-sum test was used for inter-group comparison.Results:The preoperative extension of 120 patients was 43.6°(33.8°,60.1°),the flexion was 78.7°(59.8°,98.1°),and the flexion-extension ROM was 25.6°(0.0°,54.5°);the preoperative pronation was 51.8°(33.0°,67.0°),the supination was 85.1°(65.7°,90.0°),and the rotation ROM was 136.9°(99.1°,157.5°).Postoperative extension was 14.2°(7.0°,24.8°),flexion was 129.5°(120.0°,138.1°),flexion-extension ROM was 115.5°(94.4°,127.3°);postoperative pronation was 65.0°(47.1°,75.0°),the supination was 88.3°(78.6°,90.0°),and the rotation ROM was 151.9°(131.7°,163.4°).Postoperative extension,flexion,flexion-extension ROM,pronation,supination,and rotation ROM were all higher than those before operation,and the differences were statistically significant(P<0.001).The VAS of 120 patients was 1.0(0.0,3.0) scores before operation and 0.0(0.0,1.0) scores after operation.The MEPS was 60.0(50.0,75.0)scores before operation and 100.0(85.0,100.0)scores after operation.The preoperative DASH was 37.5(20.1,51.3) scores,and the postoperative DASH was 7.9(3.3,13.3) scores.The postoperative VAS,MEPS,and DASH were significantly improved compared with those before operation,and the differences were statistically significant(P<0.001).Residual ulnar nerve symptoms occurred in 18 cases,recurrence of heterotopic ossification in 42 cases,and hematoma in 3 cases.Conclusions:Modified open elbow arthrolysis is a safe and effective surgical method for the treatment of traumatic elbow stiffness.It can significantly improve the function of the patient,reduce the occurrence of elbow instability,avoid the use of external fixators,and reduce the cost of the patient.