Brach Paul, Goitz Robert J
Hand and Upper Extremity Rehabilitation Program, Centers for Rehab Services, Pittsburgh, Pennsylvania 15213, USA.
J Hand Ther. 2006 Apr-Jun;19(2):228-36. doi: 10.1197/j.jht.2006.02.013.
Elbow arthroscopy allows for direct visualization into the elbow joint, minimizes the potential for postoperative edema and discomfort, as well as protects the ligamentous structures. Arthroscopic procedures for the elbow and postoperative management are described for patients who have undergone loose body removal, synovectomy, and capsulectomy. The effect of early mobilization on the elbow complex and the role that splinting may play, as well as the controversies surrounding the use of continuous passive motion are discussed. Arthroscopy can significantly reduce the time frame, as well as improve the functional outcome, of a postoperative rehabilitative program. There is evidence to support the reduced need for postoperative therapy, as well as quicker return to premorbid activity. However, the evidence to suggest that there is significant difference between open vs. arthroscopic repairs with regard to functional outcome is inconsequential. Complications after an arthroscopic release can arise, such as prolonged edema, which may lead to protracted joint stiffness or delayed healing. Iatrogenic nerve injury is also a potential risk that may pose devastating consequences for the individual's functional outcome. In light of all these facts, it is imperative that arthroscopic procedures be performed by experienced surgeons, who can then refer the patient to a skilled hand therapist who will work in conjunction with and communicate to the physician if complications arise.
肘关节镜检查可直接观察肘关节内部情况,将术后水肿和不适的可能性降至最低,并保护韧带结构。本文描述了接受游离体取出、滑膜切除术和关节囊切除术的患者的肘关节镜手术及术后处理。讨论了早期活动对肘关节复合体的影响、夹板固定可能发挥的作用,以及围绕持续被动运动使用的争议。关节镜检查可显著缩短术后康复计划的时间框架,并改善功能结局。有证据支持减少术后治疗需求以及更快恢复病前活动。然而,关于开放修复与关节镜修复在功能结局方面是否存在显著差异的证据并不充分。关节镜松解术后可能出现并发症,如持续性水肿,这可能导致关节长期僵硬或愈合延迟。医源性神经损伤也是一种潜在风险,可能对个体的功能结局造成严重后果。鉴于所有这些事实,至关重要的是,关节镜手术应由经验丰富的外科医生进行,然后外科医生可将患者转介给技术熟练的手部治疗师,后者将与医生协同工作,并在出现并发症时与医生沟通。