全关节镜松解术治疗肘关节僵硬的影响因素分析
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摘要
目的对比研究不同因素对肘关节僵硬全关节镜松解治疗效果的影响。方法对129例肘关节僵硬患者行全关节镜松解治疗。全关节镜下清理肘关节尺骨冠突、鹰嘴、肱骨冠突窝、鹰嘴窝及内外侧间沟等部位的瘢痕及骨赘,术毕施以手法松解。术后常规冰敷1周,术后1 d即在可调支具保护下进行屈伸锻炼。术后平均随访18.4月,分别于术前及术后6个月对患者进行肘关节活动度(ROM)测定,分析比较不同因素对手术效果的影响。结果所有病例ROM均获改善,平均改善(70.36±11.26)°。其中,骨性关节炎的松解效果较其他病因的治疗效果稍差(P<0.05)。对肱骨远端骨折所致僵硬的疗效差于尺桡骨骨折所致僵硬(P<0.05)。另外,年龄和病程对手术效果也具有影响(均P<0.05)。结论在病因因素中,骨性关节炎引起的肘关节僵硬,关节镜治疗效果相对不佳,肱骨远端骨折较尺桡骨骨折效果差,老年患者及病程长者,手术效果次于年轻和病程较短者。
Objective The purpose of this study was to investigate and compare the effects of different factors on the treatment of elbow joint stiffness with total arthroscopic arthrolysis.Methods A total of 129 patients with elbow stiffness treated with total arthroscopic lysis were followed up for a mean of 18.4 months.The patients were examined by ROM before and 6 months after surgery.The effects of different factors on the surgical outcome were analyzed.Surgical method was as follows:the scars and osteophyte in elbow joint(including ulnar coronoid process,olecranon,humeral coronal fossa,olecranon fossa and medial and lateral groove)were cleaned under microscope.After operation,ice compress was applied for 1 week,the flexion and extension exercise was performed under the protection of the adjustable brace 1 day after the operation.Results The ROM of this group was improved,with an average of(70.36±11.26)°.Among them,effect of arthrolysis was the worst in osteoarthritis(P<0.05).It was worse in distal humerus fracture than in ulnar and radius fracture(P<0.05).In addition,age and duration of the disease also had an effect on the surgical outcome(P<0.05).Conclusion Among the etiology factors,the arthroscopic treatment of elbow joint stiffness caused by osteoarthritis is relatively inferior.The method is less effective for the distal humerus fracture than for the ulna and radius fracture.The elderly patients and the patients with a longer duration have worse surgical outcomes than those of younger age and shorter duration.
Objective The purpose of this study was to investigate and compare the effects of different factors on the treatment of elbow joint stiffness with total arthroscopic arthrolysis.Methods A total of 129 patients with elbow stiffness treated with total arthroscopic lysis were followed up for a mean of 18.4 months.The patients were examined by ROM before and 6 months after surgery.The effects of different factors on the surgical outcome were analyzed.Surgical method was as follows:the scars and osteophyte in elbow joint(including ulnar coronoid process,olecranon,humeral coronal fossa,olecranon fossa and medial and lateral groove)were cleaned under microscope.After operation,ice compress was applied for 1 week,the flexion and extension exercise was performed under the protection of the adjustable brace 1 day after the operation.Results The ROM of this group was improved,with an average of(70.36±11.26)°.Among them,effect of arthrolysis was the worst in osteoarthritis(P<0.05).It was worse in distal humerus fracture than in ulnar and radius fracture(P<0.05).In addition,age and duration of the disease also had an effect on the surgical outcome(P<0.05).Conclusion Among the etiology factors,the arthroscopic treatment of elbow joint stiffness caused by osteoarthritis is relatively inferior.The method is less effective for the distal humerus fracture than for the ulna and radius fracture.The elderly patients and the patients with a longer duration have worse surgical outcomes than those of younger age and shorter duration.
引文
[1] Cefo I,Eygendaal D.Arthroscopic arthrolysis for posttraumatic elbow stiffness[J].J Shoulder Elbow Surg,2011,20(3):434-439.
[2] Cai J,Wang W,Yan H,et al.Complications of open elbow arthrolysis in post-traumatic elbow stiffness:A systematic review[J].PLoS One,2015,10(9):e0138547.
[3] 张经纬,汪春阳,范存义.肘关节僵硬治疗研究进展[J].国际骨科学杂志,2013,34(3):160-163.
[4] Kodde I F,van Rijn J,van den Bekerom M P,et al.Surgical treatment of post-traumatic elbow stiffness:A systematic review[J].J Shoulder Elbow Surg,2013,22(4):574-580.
[5] Higgs Z C,Danks B A,Sibinski M,et al.Outcomes of open arthrolysis of the elbow without post-operative passive stretching[J].J Bone Joint Surg Br,2012,94(3):348-352.
[6] Gundlach U,Eygendaal D.Surgical treatment of posttraumatic stiffness of the elbow:2-year outcome in 21 patients after a column procedure[J].Acta Orthop,2008,79(1):74-77.
[7] Sahajpal D,Choi T,Wright T W.Arthroscopic release of the stiff elbow[J].J Hand Surg Am,2009,34(3):540-544.
[8] Valero González F S,Gutiérrez Sevilla G R,Aquilera Zepeda J M,et al.Open surgical treatment in post-traumatic elbow stiffness[J].Acta Ortop Mex,2008,22(4):228-232.
[9] Fan D,Wang W,Hildebrand K A,et al.Open arthrolysis for elbow stiffness increases carrying angle but has no impact on functional recovery[J].BMC Musculoskelet Disord,2016,17(1):388.
[10] 蔡江瑜,刘家志,范存义.肘关节开放松解联合内固定取出术治疗创伤后肘关节僵硬[J].中国修复重建外科杂志,2015,29(7):826-830.
[11] 霍丽丽,邱国良,张长青.关节镜下治疗肘关节骨性关节炎的疗效观察[J].河北医科大学学报,2011,32(2):211-212.
[12] Merolla G,Buononato C,Chillemi C,et al.Arthroscopic joint debridement and capsular arthrolysis in primary and post-traumatic elbow osteoarthritis:A retrospective blinded cohort study with minimum 24-month follow-up[J].Musculoskelet Surg,2015,99(Suppl.1):S83-S90.
[13] 杨明,张殿英,付中国,等.开放肘关节松解术治疗17例肘关节僵硬患者[J].北京大学学报:医学版,2012,44(6):870-873.
[14] Koh K H,Lim T K,Lee H I.Surgical release of elbow stiffness after internal fixation of intercondylar fracture of the distal humerus[J].J Shoulder Elbow Surg,2013,22(2):268-274.
[15] Chammas M.Post-traumatic osteoarthritis of the elbow[J].Orthop Traumatol Surg Res,2014,100(Suppl.1):S15-S24.
[16] 郭祁,何大炜,孙宁,等.创伤后肘关节僵硬553例回顾性分析[J].中华外科杂志 ,2015,53(2):85-89.
[2] Cai J,Wang W,Yan H,et al.Complications of open elbow arthrolysis in post-traumatic elbow stiffness:A systematic review[J].PLoS One,2015,10(9):e0138547.
[3] 张经纬,汪春阳,范存义.肘关节僵硬治疗研究进展[J].国际骨科学杂志,2013,34(3):160-163.
[4] Kodde I F,van Rijn J,van den Bekerom M P,et al.Surgical treatment of post-traumatic elbow stiffness:A systematic review[J].J Shoulder Elbow Surg,2013,22(4):574-580.
[5] Higgs Z C,Danks B A,Sibinski M,et al.Outcomes of open arthrolysis of the elbow without post-operative passive stretching[J].J Bone Joint Surg Br,2012,94(3):348-352.
[6] Gundlach U,Eygendaal D.Surgical treatment of posttraumatic stiffness of the elbow:2-year outcome in 21 patients after a column procedure[J].Acta Orthop,2008,79(1):74-77.
[7] Sahajpal D,Choi T,Wright T W.Arthroscopic release of the stiff elbow[J].J Hand Surg Am,2009,34(3):540-544.
[8] Valero González F S,Gutiérrez Sevilla G R,Aquilera Zepeda J M,et al.Open surgical treatment in post-traumatic elbow stiffness[J].Acta Ortop Mex,2008,22(4):228-232.
[9] Fan D,Wang W,Hildebrand K A,et al.Open arthrolysis for elbow stiffness increases carrying angle but has no impact on functional recovery[J].BMC Musculoskelet Disord,2016,17(1):388.
[10] 蔡江瑜,刘家志,范存义.肘关节开放松解联合内固定取出术治疗创伤后肘关节僵硬[J].中国修复重建外科杂志,2015,29(7):826-830.
[11] 霍丽丽,邱国良,张长青.关节镜下治疗肘关节骨性关节炎的疗效观察[J].河北医科大学学报,2011,32(2):211-212.
[12] Merolla G,Buononato C,Chillemi C,et al.Arthroscopic joint debridement and capsular arthrolysis in primary and post-traumatic elbow osteoarthritis:A retrospective blinded cohort study with minimum 24-month follow-up[J].Musculoskelet Surg,2015,99(Suppl.1):S83-S90.
[13] 杨明,张殿英,付中国,等.开放肘关节松解术治疗17例肘关节僵硬患者[J].北京大学学报:医学版,2012,44(6):870-873.
[14] Koh K H,Lim T K,Lee H I.Surgical release of elbow stiffness after internal fixation of intercondylar fracture of the distal humerus[J].J Shoulder Elbow Surg,2013,22(2):268-274.
[15] Chammas M.Post-traumatic osteoarthritis of the elbow[J].Orthop Traumatol Surg Res,2014,100(Suppl.1):S15-S24.
[16] 郭祁,何大炜,孙宁,等.创伤后肘关节僵硬553例回顾性分析[J].中华外科杂志 ,2015,53(2):85-89.