CAJ | 학술논문

目的探讨关节镜下手术治疗肘关节僵硬的临床效果.方法 2003年12月-2006年12月,采用关节镜下手术治疗肘关节僵硬15例.发病到手术时间为6个月至20年,平均39.6个月.采用前外侧、前内侧、后外侧正中、后外侧上方四个入路进行镜下清理和松解术,3例附加后正中人路施行镜下鹰嘴窝开窗扩大成形术,最后行手法松解.结果术后随访时间为18～36个月(平均26.3个月).术前肘关节屈曲活动度为[(100.0±13.1)°,-/x±s,下同],伸直活动度为(47.9±11.9)°,活动范围为(52.1±11.6)°.术后肘关节屈曲活动度提高到(133.0±19.4)°,伸直活动度提高到(8.7±8.8)°,活动范围提高到(124.3±27.3)°.肘关节功能评分:优2例,良8例,一般4例,差1例;优良率为67%.结论肘关节镜下手术具有创伤小、出血少、恢复快及视野清晰的优点,但治疗效果并不一致.对于关节软骨损伤严重者,手术可能不能完全阻止疾病的发展,临床上应慎重开展.
목적 탐토관절경하수술치료주관절강경적림상효과.방법 2003년12월-2006년12월,채용관절경하수술치료주관절강경15례.발병도수술시간위6개월지20년,평균39.6개월.채용전외측、전내측、후외측정중、후외측상방사개입로진행경하청리화송해술,3례부가후정중인로시행경하응취와개창확대성형술,최후행수법송해.결과 술후수방시간위18～36개월(평균26.3개월).술전주관절굴곡활동도위[(100.0±13.1)°,-/x±s,하동],신직활동도위(47.9±11.9)°,활동범위위(52.1±11.6)°.술후주관절굴곡활동도제고도(133.0±19.4)°,신직활동도제고도(8.7±8.8)°,활동범위제고도(124.3±27.3)°.주관절공능평분:우2례,량8례,일반4례,차1례;우량솔위67%.결론 주관절경하수술구유창상소、출혈소、회복쾌급시야청석적우점,단치료효과병불일치.대우관절연골손상엄중자,수술가능불능완전조지질병적발전,림상상응신중개전.
Objective To evaluate the results of arthroscopic surgery for treatment of stiff elbow. Methods From December 2003 to December 2006,15 cases of elbow stiffness were treated arthroscopically. The time duration from onset to surgery ranged from 6 months to 20 years (mean, 39.6 months). Four portals (anterolateral, anteromedial, postero-lateral-central, and postero-lateral-upper) were routinely used for arthroscopic debridement and release. A posterocentral portal was added to perform olecranon fussa fenestration enlargement plasty under arthroscopic control in 3 cases. Finally, manual release was performed. Results All cases were followed up for 18 to 36 months (mean, 26.3 months). Before the surgery, elbow flexion was (100.0±13.1)°, extension (47.9±11.9)°, and the arc of motion was (52.1±11.6)°. At the last follow up, elbow flexion was improved to (133.0±19.4)°,extensiun to (8.7±8.8)°,and the arc of motion was improved to (124.3±27.3)°. According to the modified Andrews elbow rating scale, results of 2 cases were rated as excellent, 8 cases as good, 4 cases as fair and 1 case as poor. Thus, the excellent and good rate was 67 %. Conclusion Arthroscopic surgery to treat elbow stiffness has such advantages as minimally-invasiveness, less blood loss, fast recovery and clear visualization. However the results are not always consistent. As for cases with serious cartilage damage, it seems that arthroscopic surgery cannot completely prevent progression of the disease. Therefore, the surgery should be indicated with a cautious manner.