CAJ | 학술논문

目的探讨关节松解术配合铰链式外固定支架治疗肘关节强直的方法及效果.方法回顾性分析我院2011年7月至2012年8月收治的肘关节强直患者共21例21肘,其中男13例,女8例;平均年龄41岁.术前患肘均为完全僵硬,关节活动度(ROM)为0°.根据患者具体情况通过取出内固定物、清除异位骨化、松解挛缩软组织及瘢痕、游离松解尺神经等方法,改善患者肘关节活动度并维持肘关节稳定性及血管神经组织的低张力,术后安装铰链式外固定支架,在医生指导下按计划进行严格的功能锻炼,定期随诊,测量术前及术后屈伸活动度并进行Mayo肘关节功能评分(MEPS),随访并发症发生情况.结果术后平均随访时间为17.8个月,术后ROM为60° ～ 145°,均值为(120.2±22.3)°,Mayo评分由术前的(64.5±10.8)增至(86.7±11.5),t=-8.179,P＜0.05,其中优11例、良8例、可1例、差1例.结论对肘关节强直患者行开放性松解术切除异位骨、清理关节、松解软组织及重建稳定性,术后在铰链式外固定支架辅助下进行功能康复,可以获得较好的治疗效果.
목적 탐토관절송해술배합교련식외고정지가치료주관절강직적방법급효과.방법 회고성분석아원2011년7월지2012년8월수치적주관절강직환자공21례21주,기중남13례,녀8례;평균년령41세.술전환주균위완전강경,관절활동도(ROM)위0°.근거환자구체정황통과취출내고정물、청제이위골화、송해련축연조직급반흔、유리송해척신경등방법,개선환자주관절활동도병유지주관절은정성급혈관신경조직적저장력,술후안장교련식외고정지가,재의생지도하안계화진행엄격적공능단련,정기수진,측량술전급술후굴신활동도병진행Mayo주관절공능평분(MEPS),수방병발증발생정황.결과 술후평균수방시간위17.8개월,술후ROM위60° ～ 145°,균치위(120.2±22.3)°,Mayo평분유술전적(64.5±10.8)증지(86.7±11.5),t=-8.179,P＜0.05,기중우11례、량8례、가1례、차1례.결론 대주관절강직환자행개방성송해술절제이위골、청리관절、송해연조직급중건은정성,술후재교련식외고정지가보조하진행공능강복,가이획득교호적치료효과.
Objective To investigate the techniques and outcomes of treating elbow ankylosis with surgical arthrolysis and hinged external fixator.Methods A retrospectively review was conducted to 21 cases of elbow ankylosis treated during July 2011 to August 2012 in our hospital.There were 13 males and 8 females,and the average age was 41 years.The preoperative range of motion (ROM) of all the patients was 0,confirming the diagnosis of complete ankylosis.Removal of internal fixation hard wares,resection of heterotopic ossification,soft tissue release and subcutaneous anterior transposition of the ulnar nerve were performed.The ROM was improved while the stability of elbow joints was maintained,as well as low tension of the neurovascular structures.Hinged external fixator was applied postoperatively to fulfill monitored functional rehabilitation.ROM and Mayo Elbow Performance Score (MEPS) were observed and incidence of complication was recorded.Results The average postoperative follow-up time was 17.8 months.The ROM was 60° to 145°,with an average of (120.2 ± 22.3)°.MEPS improved from (64.5 ± 10.8) to (86.7 ± 11.5),(t =-8.179,P ＜ 0.05),with outcomes recognized as excellent in 11 cases,good in 8 cases,fair in 1 case and poor in 1 case.Conclusion Surgical arthrolysis associated with external fixator application and functional rehabilitation can be an effective treatment for elbow ankylosis.