创伤后肘关节僵硬的手术治疗

Surgical treatment of the post-traumatic stiff elbows

目的报告手术松解和术后康复治疗外源性创伤后肘关节僵硬的方法和效果。方法自1999年12月～2002年2月,对14例肘关节僵硬进行手术松解,经内、外侧或联合入路,保留关节内侧副韧带的前束和外侧副韧带的尺束,彻底清除关节周围的异化骨,挛缩的次要韧带和关节囊,恢复肘关节活动度。术后配合康复理疗。结果随访6～25个月,平均14.2个月。患肘关节的活动范围术后较术前平均增加75°;术后平均最大伸展度为7.9°,平均最大屈曲度为110.7°。无1例发生伤口感染,术后关节不稳,明显疼痛等并发症。依据Mayo肘关节功能评定标准,术前关节功能良3例,中9例,差2例;术后关节功能优11例,良2例,差1例。结论对于外源性创伤后肘关节僵硬,适时手术松解及术后康复有利于关节活动功能的恢复。

Objective To report the method and results of the arthrolysis for the extrinsic post traumatic stiff elbows and post operative rehabilitation after the treatment. Methods From Dec. 1999 to Feb. 2002, 14 cases of such stiff elbows were treated surgically through medial, lateral or combined approaches. To retain the range of motion, the heterotopic osteophytes, contractured minor ligaments, capsule and fibrous tissue were get rid of thoroughly while the anterior band of the medial collateral ligament and the lateral ulnar collateral ligament were preserved. The rehabilitation ensued immediately after operation. Results After an average follow up period of 14.2 months, the mean maximum extension after the arthrolysis was 7.9 degrees, the average maximum flexion was 110.7 degrees and the average total range of motion increased by 75 degrees. No such complications as incision infection, iatrogenic elbow instability or debilitating pain were discovered in this series. By Mayo elbow performance index, 11cases were considered excellent, 2 good, and 1 poor postoperatively, while 3 cases were good, 9 fair and 2 poor preoperatively. Conclusion To treat extrinsic post traumatic stiff elbows, the surgical intervention at appropriate time and post operative rehabilitation are beneficial to the recovery of the range of motion.