改良松解术治疗创伤后肘关节僵硬的疗效及危险因素分析

Clinical prognosis and risk factors of post-traumatic elbow stiffness treated by modified elbow arthrolysis

目的分析改良肘关节松解术治疗创伤后肘关节僵硬(PTES)的临床预后,探究影响预后的危险因素。方法回顾性收集2018年6月至2021年1月于我院行改良松解术的PTES患者的临床资料。首先,对患者术前及末次随访功能进行比较分析;随后,根据末次随访关节活动度将患者分为预后良好和预后不良两组,通过多因素分析,探究导致预后不良的危险因素。结果本研究纳入了127例患者,男77例,女50例,平均年龄(36.9±12.3)岁,平均随访时间(22.7±10.8)个月(12~45个月)。末次随访肘关节屈伸活动度较术前增加70.8°,前臂旋转活动度较术前增加14.3°;MEPS评分较术前增加30.0分;DASH评分较术前减少25.0分,VAS评分较术前减少0.0分。通过多因素分析,青少年、中老年、肥胖、主利手侧、原始开放损伤、受伤至松解时间超过2年,以及术前存在PTOA为PTES行改良松解术预后不良的独立危险因素。结论改良松解术治疗PTES,总体可获得相对满意的临床预后。年龄、肥胖、主利手侧、原始开放损伤、受伤至松解时间过长,以及术前存在PTOA为PTES行改良松解术预后不良的危险因素。

Objectives To analyze the clinical prognosis of modified elbow arthrolysis in the treatment of post-traumatic elbow stiffness(PTES),and to analyse the prognostic risk factors of OEA.Methods We retrospectively collected the clinical data of patients with PTES at our institution between June 2018 and January 2021.Firstly,we compared the functional outcomes before surgery and at the last follow-up.Secondly,based on the elbow ROM,we divided the patients into two groups,identified the risk factors that affect the prognosis using multivariate logistic regression.Results The data of 127 patients(77 males,50 females)of PTES was collected.The mean age is(36.9±12.3)years.The mean follow-up time is 22.7±10.8 months(12-45 months).At the last follow-up,the ROM of flexion and extension increased 70.8°than that before surgery,the ROM of the forearm rotation increased 14.3°,the MEPS increased 30.0,the DASH decreasd 25.0,and the VAS decreasd to 0.0(0.0,3.0).Through the multivariate analysis,the adolescent,middle and elderly patients,obesity,the dominant arm,the initial open fracture,the time from the initial injury to the OEA,and having PTOA before OEA were the independent risk factors that affect the prognosis.Conclusions Modified elbow arthrolysis can get good prognosis in the treatment of PTES.Age,obesity,the dominant arm,the initial open fracture,the time from the initial injury to the OEA,and having PTOA before OEA were the independent risk factors that affect the prognosis.