中华创伤杂志
中華創傷雜誌
중화창상잡지
Chinese Journal of Traumatology
2013年
5期
416-419
,共4页
东靖明%张庆宇%田旭%马宝通
東靖明%張慶宇%田旭%馬寶通
동정명%장경우%전욱%마보통
肘关节%骨化,异位性%关节僵硬
肘關節%骨化,異位性%關節僵硬
주관절%골화,이위성%관절강경
Elbow joint%Ossification,heterotopic%Ankylosis
目的 探讨手术松解治疗合并异位骨化的创伤后肘关节僵硬的方法与疗效.方法 选择2007年6月-2011年6月收治的16例手术松解治疗以合并异位骨化的创伤后肘关节僵硬患者,其中男11例,女5例;年龄18 ～53岁,平均29.6岁.受伤至手术时间平均10.7个月(8 ～14个月).除1例患者单独采用内侧入路外,其他均采用内外联合入路,彻底清除关节周围的异位骨化及增生组织,切除部分关节囊及韧带.其中7例患者采用铰链式外固定支架固定.术后口服塞来昔布3周,早期开始功能训练.采用关节活动度(range of motion,ROM)及Mayo肘关节功能评分(Mayo elbow performance score,MEPS)对疗效进行评定.结果 16例患者术后获8～17个月(平均13.4个月)随访.肘关节术前平均ROM范围:伸直受限(45.2±3.5)°,屈曲(68.1±11.8)°,旋前(55.8±8.2)°,旋后(53.7±6.3)°.术后平均ROM范围:伸直受限(27.2±8.4)°,屈曲(106.8±16.4)°,旋前(80.5±3.3)°,旋后(83.1±5.3)°.术前、术后平均ROM范围差异均有统计学意义(P＜0.01).MEPS由术前(46.8±7.0)分上升至术后(83.2±9.4)分(P＜0.01).MEPS评分标准:优7例,良5例,可4例.结论 对于合并异位骨化的创伤后肘关节僵硬患者,术前全面评估、严格把握手术适应证,术中采用恰当的手术治疗技术,术后早期系统功能训练,可获得满意的治疗效果.
目的 探討手術鬆解治療閤併異位骨化的創傷後肘關節僵硬的方法與療效.方法 選擇2007年6月-2011年6月收治的16例手術鬆解治療以閤併異位骨化的創傷後肘關節僵硬患者,其中男11例,女5例;年齡18 ～53歲,平均29.6歲.受傷至手術時間平均10.7箇月(8 ～14箇月).除1例患者單獨採用內側入路外,其他均採用內外聯閤入路,徹底清除關節週圍的異位骨化及增生組織,切除部分關節囊及韌帶.其中7例患者採用鉸鏈式外固定支架固定.術後口服塞來昔佈3週,早期開始功能訓練.採用關節活動度(range of motion,ROM)及Mayo肘關節功能評分(Mayo elbow performance score,MEPS)對療效進行評定.結果 16例患者術後穫8～17箇月(平均13.4箇月)隨訪.肘關節術前平均ROM範圍:伸直受限(45.2±3.5)°,屈麯(68.1±11.8)°,鏇前(55.8±8.2)°,鏇後(53.7±6.3)°.術後平均ROM範圍:伸直受限(27.2±8.4)°,屈麯(106.8±16.4)°,鏇前(80.5±3.3)°,鏇後(83.1±5.3)°.術前、術後平均ROM範圍差異均有統計學意義(P＜0.01).MEPS由術前(46.8±7.0)分上升至術後(83.2±9.4)分(P＜0.01).MEPS評分標準:優7例,良5例,可4例.結論 對于閤併異位骨化的創傷後肘關節僵硬患者,術前全麵評估、嚴格把握手術適應證,術中採用恰噹的手術治療技術,術後早期繫統功能訓練,可穫得滿意的治療效果.
목적 탐토수술송해치료합병이위골화적창상후주관절강경적방법여료효.방법 선택2007년6월-2011년6월수치적16례수술송해치료이합병이위골화적창상후주관절강경환자,기중남11례,녀5례;년령18 ～53세,평균29.6세.수상지수술시간평균10.7개월(8 ～14개월).제1례환자단독채용내측입로외,기타균채용내외연합입로,철저청제관절주위적이위골화급증생조직,절제부분관절낭급인대.기중7례환자채용교련식외고정지가고정.술후구복새래석포3주,조기개시공능훈련.채용관절활동도(range of motion,ROM)급Mayo주관절공능평분(Mayo elbow performance score,MEPS)대료효진행평정.결과 16례환자술후획8～17개월(평균13.4개월)수방.주관절술전평균ROM범위:신직수한(45.2±3.5)°,굴곡(68.1±11.8)°,선전(55.8±8.2)°,선후(53.7±6.3)°.술후평균ROM범위:신직수한(27.2±8.4)°,굴곡(106.8±16.4)°,선전(80.5±3.3)°,선후(83.1±5.3)°.술전、술후평균ROM범위차이균유통계학의의(P＜0.01).MEPS유술전(46.8±7.0)분상승지술후(83.2±9.4)분(P＜0.01).MEPS평분표준:우7례,량5례,가4례.결론 대우합병이위골화적창상후주관절강경환자,술전전면평고、엄격파악수술괄응증,술중채용흡당적수술치료기술,술후조기계통공능훈련,가획득만의적치료효과.
Objective To discuss methods and clinical efficacy of patients treated with arthrolysis for posttraumatic elbow stiffness with heterotopic ossification.Methods The study involved 16 patients with posttraumatic elbow stiffness combined with heterotopic ossification treated by arthrolysis between June 2007 and June 2011.There were 11 males and 5 females,at average age of 29.6 years (range,18-53 years).Time from injury to surgery averaged 10.7 months (range,8-14 months).Other than medial approach for only one patient,the rest adopted medial to lateral approaches to have a complete clearance of periarticular heterotopic ossification tissue and hyperplastic tissue as well as partial resection of articular capsules and ligaments.Besides,seven patients were fixed using hinged external fixators.After surgery,three weeks of oral celecoxib was given for the patients.Rehabilitation was started immediately after operation.Range of motion (ROM) of the elbow and Mayo elbow pcrformance score (MEPS) were used to determine clinical results.Results All patients were followed up for 8-17 months (mean 13.4 months).ROM of the elbow (extension lag,flexion,pronation and supination)showed an improvement from (45.2-3.5)° to (27.2 ±8.4)°,(68.1-11.8)° to (106.8 ± 16.4)°,(55.8 ± 8.2) ° to (80.5 ± 3.3) °,and (53.7 ± 6.3) ° to (83.1 ± 5.3) ° respectively (P ＜ 0.01).MEPS increased from (46.8 ±7.0) points to (83.2 ±9.4) points after operation (P ＜0.01).According to MEPS criterion,the results were excellent in seven patients,good in five and fair in four.Conclusion With respect to posttraumatic elbow stiffness with heterotopic ossification,satisfactory therapeutic results can be achieved by thorough preoperative evaluation,strict control of surgical indications,appropriate selection of intraoperative techniques and early systematic rehabilitation.
