Van Heest Ann, James Michelle A, Lewica Amy, Anderson Kurt A
Department of Orthopaedic Surgery, University of Minnesota, 2450 Riverside Avenue, Suite 200, Minneapolis, MN 55454, USA.
J Bone Joint Surg Am. 2008 Jul;90(7):1517-23. doi: 10.2106/JBJS.F.01174.
Flexion of one elbow is essential to enable children with arthrogryposis to achieve independent function such as self-feeding and self-care of the face and hair. We analyzed the outcomes of posterior elbow capsulotomy with triceps lengthening for the treatment of elbow extension contractures in a series of children with arthrogryposis multiplex congenita.
The medical records of all children with arthrogryposis who had been followed for a minimum of two years after treatment with elbow capsulotomy and triceps lengthening were retrospectively reviewed. The postoperative range of motion and ability to reach the mouth were compared with the preoperative status.
Posterior capsulotomy with triceps lengthening was performed in twenty-nine elbows of twenty-three children with an average age of thirty-five months (range, seven months to thirteen years). The average duration of follow-up was 5.4 years. The arc of motion of all twenty-nine elbows improved from an average of 32 degrees (range, 0 degrees to 75 degrees) preoperatively to an average of 66 degrees (range, 10 degrees to 125 degrees) at the time of final follow-up. All children were able to reach the mouth using passive assistance (e.g., table-push, trunk-sway, and cross-arm techniques), and twenty-two children were able to feed themselves independently. No child underwent subsequent tendon transfer surgery.
Elbow capsulotomy with triceps lengthening successfully increases passive elbow flexion and the arc of elbow motion of children with arthrogryposis, enabling hand-to-mouth activities. In contrast to studies in which tendon transfer surgery was used to increase elbow flexion, none of the children in this series underwent subsequent tendon transfer surgery.
对于患有先天性多发性关节挛缩症的儿童，一侧肘部的屈曲对于实现诸如自我进食以及面部和头发的自我护理等独立功能至关重要。我们分析了一系列先天性多发性关节挛缩症儿童行肘后关节囊切开术联合肱三头肌延长术治疗肘部伸展挛缩的疗效。
回顾性分析了所有接受肘后关节囊切开术联合肱三头肌延长术治疗且术后随访至少两年的先天性多发性关节挛缩症儿童的病历。将术后的活动范围和触及口腔的能力与术前情况进行比较。
对23例平均年龄35个月（范围7个月至13岁）的儿童的29个肘部实施了肘后关节囊切开术联合肱三头肌延长术。平均随访时间为5.4年。所有29个肘部的活动弧度从术前平均32度（范围0度至75度）改善至末次随访时平均66度（范围10度至125度）。所有儿童在被动辅助（如借助桌子推、躯干摆动和交叉手臂技术）下都能够触及口腔，22例儿童能够独立进食。没有儿童接受后续的肌腱转移手术。
肘后关节囊切开术联合肱三头肌延长术成功增加了先天性多发性关节挛缩症儿童的被动肘部屈曲及肘部活动弧度，使手能够触及口腔。与使用肌腱转移手术增加肘部屈曲的研究不同，本系列中没有儿童接受后续的肌腱转移手术。
