Dávila Sylvia A, Johnston-Jones Karen
Hand Rehabilitation Associates of San Antonio, Inc., San Antonio, Texas 78240, USA.
J Hand Ther. 2006 Apr-Jun;19(2):268-81. doi: 10.1197/j.jht.2006.02.017.
Elbow contracture may be caused by intrinsic or extrinsic limitations or a combination of both. Evaluation of the specific structures guides the development of an effective therapy treatment program. Intrinsic contractures are by definition due to joint/intra-articular incongruency, and therefore therapy and splinting cannot provide increase in joint motion. Nonoperative therapy treatment options include heat modalities, myofascial soft tissue mobilization, joint mobilization, muscle energy techniques, passive range of motion, active range of motion, extensive use of corrective splinting, and strengthening exercise. All operative candidates must participate in a preoperative therapy program of six to eight weeks to reduce extrinsic contractures as feasible and to assess patient compliance with an intensive postoperative therapy program. Corrective splinting may be needed for as long as six months to maintain gains made in surgery. The therapy following manipulation under anesthesia and open contracture release is similar. The therapist must know the details of the procedure. Operative treatment for the stiff elbow progresses in a sequential fashion to progressively release tissue structures limiting motion and reconstruct any structures as needed to provide joint stability. Postoperative therapy consists of continuous passive motion , corrective splinting, modalities, and specific exercise techniques to maintain passive gains achieved in surgery. The therapy is extensive and requires full participation from the patient to maximize motion and function. Complications of elbow contracture release include nerve palsy or nerve injury, seroma, joint instability, heterotopic ossification, and recurrence of elbow contracture.
肘关节挛缩可能由内在或外在限制因素引起，或两者兼而有之。对特定结构的评估有助于制定有效的治疗方案。根据定义，内在挛缩是由于关节/关节内不协调所致，因此治疗和夹板固定无法增加关节活动度。非手术治疗选择包括热疗、肌筋膜软组织松动术、关节松动术、肌肉能量技术、被动活动范围、主动活动范围、广泛使用矫正夹板以及强化锻炼。所有手术候选者必须参加为期六至八周的术前治疗方案，以尽可能减少外在挛缩，并评估患者对术后强化治疗方案的依从性。可能需要长达六个月的矫正夹板固定，以维持手术取得的效果。麻醉下手法治疗和开放性挛缩松解术后的治疗相似。治疗师必须了解手术过程的细节。僵硬肘关节的手术治疗按顺序进行，逐步松解限制活动的组织结构，并根据需要重建任何结构以提供关节稳定性。术后治疗包括持续被动活动、矫正夹板固定、物理治疗以及特定的锻炼技术，以维持手术中获得的被动活动效果。治疗范围广泛，需要患者充分参与以最大限度地恢复活动度和功能。肘关节挛缩松解的并发症包括神经麻痹或神经损伤、血清肿、关节不稳定、异位骨化以及肘关节挛缩复发。
