Gausepohl Thomas, Mader Konrad, Pennig Dietmar
Department of Trauma Surgery, Hand and Reconstructive Surgery, St.Vinzenz-Hospital, Merheimer Strasse 221-223, D-50733 Cologne, Germany.
J Bone Joint Surg Am. 2006 May;88(5):1011-21. doi: 10.2106/JBJS.D.02090.
Elbow contracture is a recognized sequela of elbow injuries in children and adolescents, but previous studies of operative treatment with formal capsular release have demonstrated unpredictable outcomes and unfavorable results.
Over a period of five years, fourteen children and adolescents with a mean age of fourteen years who had posttraumatic stiffness of the elbow were managed according to a prospective protocol. Eleven patients had undergone a mean of three previous operative procedures before the index operation. After intraoperative distraction with an external fixator, there was a relaxation phase for six days followed by mobilization of the elbow joint under distraction in the fixator for a mean of seven weeks. Intraoperative range of motion under distraction reached a mean of 100 degrees. Open arthrolysis was not performed, but in four children impinging heterotopic bone was removed through a limited approach. Decompression of the ulnar nerve was performed in seven patients.
The mean preoperative arc of total elbow motion was 37 degrees. The mean pronation was 46 degrees, and the mean supination was 56 degrees. After a mean duration of follow-up of thirty-four months, all patients but two had achieved a functional arc of motion of 100 degrees. The mean arc of flexion-extension was 108 degrees (range, 75 degrees to 130 degrees). The mean range of pronation was 73 degrees (range, 20 degrees to 90 degrees), and the mean range of supination was 75 degrees (range, 10 degrees to 90 degrees). There were no pin-track infections or deep infections, and all elbows were stable. At the time of follow-up, three patients had radiographic evidence of humeroulnar degeneration.
Closed distraction of the elbow joint with use of a monolateral external fixation frame with motion capacity yields more favorable results than other previously reported options for the treatment of posttraumatic elbow contractures in children and adolescents.
肘关节挛缩是儿童和青少年肘部损伤公认的后遗症，但先前关于正式关节囊松解术的手术治疗研究显示，其结果不可预测且效果不佳。
在五年时间里，对14名平均年龄为14岁的创伤后肘关节僵硬的儿童和青少年按照前瞻性方案进行治疗。11名患者在本次手术前平均接受过三次先前的手术。术中使用外固定架进行牵引后，有六天的放松期，随后在固定架牵引下对肘关节进行平均七周的活动。术中牵引下的活动范围平均达到100度。未进行开放性关节松解术，但对四名儿童通过有限的方法切除了撞击的异位骨。七名患者进行了尺神经减压。
术前肘关节总活动弧度平均为37度。平均旋前为46度，平均旋后为56度。平均随访34个月后，除两名患者外，所有患者均达到了100度的功能性活动弧度。屈伸平均弧度为108度（范围为75度至130度）。平均旋前范围为73度（范围为20度至90度），平均旋后范围为75度（范围为10度至90度）。没有针道感染或深部感染，所有肘关节均稳定。随访时，三名患者有肱骨尺骨退变的影像学证据。
对于儿童和青少年创伤后肘关节挛缩的治疗，使用具有活动能力的单侧外固定架进行肘关节闭合牵引比先前报道的其他方法产生更有利的结果。
