中华创伤骨科杂志
中華創傷骨科雜誌
중화창상골과잡지
Chinese Journal of Orthopaedic Trauma
2015年
10期
832-837
,共6页
何大炜%蒋协远%公茂琪%查晔军
何大煒%蔣協遠%公茂琪%查曄軍
하대위%장협원%공무기%사엽군
肘关节%僵硬%外固定器%松解术
肘關節%僵硬%外固定器%鬆解術
주관절%강경%외고정기%송해술
Elbow joint%Stiffness%External fixators%Arthrolysis
目的 探讨开放松解术结合Stryker DJDⅡ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Stryker DJDⅡ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、外侧联合入路或后正中入路;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Stryker DJDⅡ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.
目的 探討開放鬆解術結閤Stryker DJDⅡ鉸鏈式外固定支架治療極重度肘關節僵硬患者的療效. 方法 迴顧性分析2011年1月至2012年12月收治的42例極重度創傷後肘關節僵硬[(屈伸活動範圍(ROM)＜30°)]患者資料,男28例,女14例;年齡21～67歲,平均39.4歲.所有患者均行肘關節鬆解術,併聯閤Stryker DJDⅡ鉸鏈式外固定支架固定.受傷至鬆解術時間平均為11.8箇月(6～60箇月).手術入路採用內、外側聯閤入路或後正中入路;均行呎神經鬆解併前移至皮下組織.末次隨訪時評估肘關節ROM併採用Mayo肘關節功能評分(MEPS)標準評定肘關節功能.結果 42例患者術後穫12 ～ 34箇月(平均25.5箇月)隨訪.術前與末次隨訪時比較,42例患者肘關節屈伸ROM由10.2°±11.6°(0～30°)改善至107.6°±22.0°(45°～ 135°),鏇轉ROM由105.4°±78.5°(0～180°)改善至138.9°±57.4°(0～180°),MEPS評分由(62.1±5.6)分(40～75分)改善至(89.9±10.0)分(65～100分),差異均有統計學意義(P＜0.05).末次隨訪時按照MEPS評分標準評定肘關節功能:優25例,良13例,可4例,優良率為90.5％.術後6例患者髮生呎神經功能障礙,3例患者髮生血腫,1例患者髮生傷口裂開,4例患者髮生針道輕度感染. 結論 開放鬆解術結閤Stryker DJDⅡ鉸鏈式外固定支架可有效治療極重度創傷後肘關節僵硬,併髮癥少,療效較滿意.
목적 탐토개방송해술결합Stryker DJDⅡ교련식외고정지가치료겁중도주관절강경환자적료효. 방법 회고성분석2011년1월지2012년12월수치적42례겁중도창상후주관절강경[(굴신활동범위(ROM)＜30°)]환자자료,남28례,녀14례;년령21～67세,평균39.4세.소유환자균행주관절송해술,병연합Stryker DJDⅡ교련식외고정지가고정.수상지송해술시간평균위11.8개월(6～60개월).수술입로채용내、외측연합입로혹후정중입로;균행척신경송해병전이지피하조직.말차수방시평고주관절ROM병채용Mayo주관절공능평분(MEPS)표준평정주관절공능.결과 42례환자술후획12 ～ 34개월(평균25.5개월)수방.술전여말차수방시비교,42례환자주관절굴신ROM유10.2°±11.6°(0～30°)개선지107.6°±22.0°(45°～ 135°),선전ROM유105.4°±78.5°(0～180°)개선지138.9°±57.4°(0～180°),MEPS평분유(62.1±5.6)분(40～75분)개선지(89.9±10.0)분(65～100분),차이균유통계학의의(P＜0.05).말차수방시안조MEPS평분표준평정주관절공능:우25례,량13례,가4례,우량솔위90.5％.술후6례환자발생척신경공능장애,3례환자발생혈종,1례환자발생상구렬개,4례환자발생침도경도감염. 결론 개방송해술결합Stryker DJDⅡ교련식외고정지가가유효치료겁중도창상후주관절강경,병발증소,료효교만의.
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 follow-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 included 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 Ⅱ hinged external fixator is a very effective treatment of severe posttraumatic elbow stiffness,leading to a low complication rate and satisfactory outcomes.
