Ippolito E, Formisano R, Caterini R, Farsetti P, Penta F
Department of Orthopedic Surgery, University of Rome Tor Vergata, Italy.
J Hand Surg Am. 1999 May;24(3):546-53. doi: 10.1053/jhsu.1999.0546.
Heterotopic periarticular ossifications were surgically excised in 16 elbows of 14 traumatic brain injury patients an average of 18.9 months (range, 4-67 months) after the end of coma. In 11 elbows the ulnohumeral joint was ankylosed in a position that ranged from 0 degrees to 100 degrees of flexion (group 1); in 5 elbows the arc of flexion ranged from 10 degrees to 25 degrees (group 2). Full pronation and supination were present in 15 of the elbows; in 1 the radiocapitellar joint was fixed at 30 degrees of pronation by a partial ossification of the interosseous membrane. The arc of flexion attained after surgery averaged 115 degrees (range, 90 degrees to 145 degrees) in the group 1 elbows and 128 degrees (range, 115 degrees to 140 degrees) in the group 2 elbows. In an attempt to prevent postoperative loss of motion and recurrence of ossification, continuous passive motion was applied to the affected elbow for 6 weeks before starting a fully active rehabilitation program. All the patients were examined at regular intervals after the surgery. The follow-up period ranged from 12 to 60 months (average, 30.7 months). During the follow-up period, all the elbows showed improvement in range of motion and the arc of flexion averaged 95 degrees (range, 30 degrees to 135 degrees) in the group 1 elbows and 116 degrees (range, 80 degrees to 145 degrees) in the group 2 elbows. Patients with poor neuromuscular control lost part of their postoperative range of motion and partial recurrence was observed in 3 elbows. We believe that our improved results, compared with those obtained by previous investigators, may have been due to the prolonged application of continuous passive motion after surgery.
14例创伤性脑损伤患者的16个肘部异位关节周围骨化在昏迷结束后平均18.9个月（范围4 - 67个月）进行了手术切除。11个肘部的尺肱关节在0度至100度屈曲的位置强直（第1组）；5个肘部的屈曲弧度在10度至25度之间（第2组）。15个肘部有完全的旋前和旋后功能；1个肘部桡骨头关节因骨间膜部分骨化而固定在旋前30度。第1组肘部术后达到的屈曲弧度平均为115度（范围90度至145度），第2组肘部为128度（范围115度至140度）。为防止术后运动丧失和骨化复发，在开始全面主动康复计划前，对患肘应用持续被动运动6周。所有患者术后定期接受检查。随访期为12至60个月（平均30.7个月）。在随访期内，所有肘部的活动范围均有改善，第1组肘部的屈曲弧度平均为95度（范围30度至135度），第2组肘部为116度（范围80度至145度）。神经肌肉控制差的患者术后活动范围部分丧失，3个肘部观察到部分复发。我们认为，与先前研究者的结果相比，我们改善的结果可能归因于术后持续被动运动的延长应用。
