CAJ | 학술논문

目的评估并比较采用侧方与后正中入路松解僵直肘的临床效果.方法对44例肘关节僵硬患者采用手术松解.其中22例取肘侧方入路,经内侧入路分离关节囊后壁并清理肘后侧鹰嘴窝,经外侧入路分离关节囊前壁及清理桡骨头.22例取肘后正中皮肤切口,完整分离肱三头肌以清理鹰嘴窝,两侧深层显露采用侧方肌间隙入路.结果 44例获得14～52个月(平均23.2个月)的随访.侧方人路:术后肘关节活动度平均为[(108.0±12.4)°,-/x±s,下同],术后Mayo肘关节功能评分平均为(83.4±2.4)分.后正中人路:术后肘关节活动度平均为(95.7±17.3)°,术后Mayo肘关节功能评分平均为(79.2±6.9)分.两组松解疗效差异均较术前有统计学意义(P<0.01),组间术后平均活动度差异有统计学意义(P<0.05),组间术后平均Mayo肘关节功能评分差异有统计学意义(P<0.05).结论采用侧方或后正中入路的松解方法 ,对僵直肘安全有效.肘侧方入路松解可获得比后正中人路松解更好的临床效果.
목적 평고병비교채용측방여후정중입로송해강직주적림상효과.방법 대44례주관절강경환자채용수술송해.기중22례취주측방입로,경내측입로분리관절낭후벽병청리주후측응취와,경외측입로분리관절낭전벽급청리뇨골두.22례취주후정중피부절구,완정분리굉삼두기이청리응취와,량측심층현로채용측방기간극입로.결과 44례획득14～52개월(평균23.2개월)적수방.측방인로:술후주관절활동도평균위[(108.0±12.4)°,-/x±s,하동],술후Mayo주관절공능평분평균위(83.4±2.4)분.후정중인로:술후주관절활동도평균위(95.7±17.3)°,술후Mayo주관절공능평분평균위(79.2±6.9)분.량조송해료효차이균교술전유통계학의의(P<0.01),조간술후평균활동도차이유통계학의의(P<0.05),조간술후평균Mayo주관절공능평분차이유통계학의의(P<0.05).결론 채용측방혹후정중입로적송해방법 ,대강직주안전유효.주측방입로송해가획득비후정중인로송해경호적림상효과.
Objective To evaluate and compare the clinical outcomes of stiff elbow release via combined lateral and medial approach and via posterior median approach. Methods Arthrolysis was performed in 44 cases with stiff elbow. Combination of lateral and medial approach was carried out in 22 cases. The posterior capsule was excised and the olecranon fossa was debrided through the medial approach. The anterior capsule was excised and the radial head was debfided through the lateral approach. The posterior median approach was carried out in the other 22 cases. The olecranon fossa was debridod after detachment of triceps insertion. Exposure of the deep structures on both sides of the joint was achieved by dissection via intermuscular septums. Results All patients were followed up for a mean 23.2 months (ranged from 14 to 52 months). The mean range of motion of the elbow joint in patients treated with combined lateral and medial approach was (108.0±12.4)°, while the mean Mayo Elbow Score was (83.4±2.4). The mean range of motion in patients with posterior median approach was (95.7±17.3)°, while the mean Mayo Elbow Score was (79.2±6.9). The clinical results of the two groups were statistically different (P<0.01). Range of motion and the Mayo Elbow Score between the two groups showed statistically significant differences (P<0.05). Conclusion Surgical release of stiff elbow via combined lateral and medial approach and via posterior median approach is safe and effective. Combined lateral and medial approach leads to better clinical outcomes than the posterior median approach.