摘要
目的探讨开放松解术结合StrykerDJD11铰链式外固定支架治疗极重度肘关节僵硬患者的疗效。方法回顾性分析2011年1月至2012年12月收治的42例极重度创伤后肘关节僵硬[（屈伸活动范围（ROM）〈30°）]患者资料，男28例，女14例；年龄21-67岁，平均39．4岁。所有患者均行肘关节松解术，并联合StrykerDJDⅡ铰链式外固定支架固定。受伤至松解术时间平均为11．8个月（6—60个月）。手术入路采用内、外侧联合人路或后正中入路；均行尺神经松解并前移至皮下组织。末次随访时评估肘关节ROM并采用Mayo肘关节功能评分（MEPS）标准评定肘关节功能。结果42例患者术后获12～34个月（平均25．5个月）随访。术前与末次随访时比较，42例患者肘关节屈伸ROM由10．2°±11．6°（0—30。）改善至107．6°±22．0°（45°-135°），旋转ROM由105．4°±78．5°（0～180。）改善至138．9°±57．4°（0～180°），MEPS评分由（62．1±5．6）分（40～75分）改善至（89．9±10．0）分（65～100分），差异均有统计学意义（P〈0．05）。末次随访时按照MEPS评分标准评定肘关节功能：优25例，良13例，可4例，优良率为90．5％。术后6例患者发生尺神经功能障碍，3例患者发生血肿，1例患者发生伤口裂开，4例患者发生针道轻度感染。结论开放松解术结合StrykerDJDⅡ铰链式外固定支架可有效治疗极重度创伤后肘关节僵硬，并发症少，疗效较满意。
Objective To retrospectively evaluate the results of open arthrolysis and Stryker DJD Ⅱ hinged external fixator for patients with severe posttraumatic stiffness of the elbow. Methods From January 2011 to December 2012, 42 patients with severe posttraumatic stiffness of the elbow with an arc of flexion ≤ 30° were treated with open arthrolysis and Stryker DJD Ⅱ hinged external fixator. They were 28 males and 14 females, with a mean age of 39.4 years （from 21 to 67 years）. The mean duration of stiffness was 11.8 months （from 6 to 60 months）. Operations were accomplished through the combined lateral and medial approaches or the posterior midline approach. Subcutaneous anterior transposition of the ulnar nerve was performed in all patients. At the last follow-up, the range of motion （ROM） of the elbow and the elbow function were evaluated by Mayo Elbow Performance Score （MEPS）. Results The 42 patients obtained a mean follow-up of 25.5 months （from 12 to 34 months） . Comparison between preoperation and the last fol- low-up showed that the mean ROM in extension and flexion was improved from preoperative 10. 2°± 11.6° （from 0 to 30°） to postoperative 107.6° ± 22.0° （from 45° to 135°）, the mean pronation and supination from preoperative 105.4° ±78. 5° （from 0 to 180°） to postoperative 138.9°±57.4° （from 0 to 180°）, and the mean MEPS from preoperative 62. 1 ±5.6 （from 40 to 75） to postoperative 89.9± 10. 0 （from 65 to 100）. All the differences were statistically significant （ P 〈 0. 05 ）. By the MEPS, 25 cases were rated as excellent, 13 as good, and 4 as fair, giving an excellent to good rate of 90. 5%. The postoperative complications in- eluded ulnar nerve symptom in 6 cases, hematoma in 3, wound dehiscence in one, and pin-track infection in 4. Conclusion Open arthrolysis and Stryker DJD I1 hinged external fixator is a very effective treatment of severe posttraumatie elbow stiffness, leading to a low complication rate and satisfactory outcomes.
出处
《中华创伤骨科杂志》
CAS
CSCD
北大核心
2015年第10期832-837,共6页
Chinese Journal of Orthopaedic Trauma
基金
基金项目：北京市优秀人才培养项目（2013D003034000002）
关键词
肘关节
僵硬
外固定器
松解术
Elbow joint
Stiffness
External fixators
Arthrolysis
