LIU Xing-hua, ZHANG Li-dan, JIANG Xie-yuan, WANG Man-yi
Department of Orthopaedic Trauma Surgery, Beijing Jishuitan Hospital, Beijing 100035, China.
Zhonghua Wai Ke Za Zhi. 2008 Oct 15;46(20):1568-71.
To report the method and result of open arthrolysis of patients who suffered from severe post-traumatic elbow stiffness.
Of the 12 patients, there were 9 male and 3 female, average age of 32 years old (16 - 47 years). Primary injury included 7 simple fractures, 1 simple dislocation, 2 fracture dislocations and 2 soft tissue injury. The averaged time of immobilization after injury was 3.3 weeks (0 - 8 weeks). The averaged time between injury and open arthrolysis was 6.4 months (1 - 14 months). Before open arthrolysis, the mean arc of total motion was 33.8 degrees (0 degrees - 80 degrees ). Three patients suffered from forearm rotation deficiency. Posterior approach was used for 4 patients, medial approach for 2 patients and both medial and lateral approach for 6 patients. tissues were resected, which hindered the motion of the elbow and perform proximal radioulnar joint arthrolysis for some patients. After arthrolysis, the arc of elbow motion could reach 0 degrees - 140 degrees , and for the patients who suffered from forearm rotation deficiency, pronation 80 degrees and supination 90 degrees were gotten. Ulnar nerve transposition was not a routine. The patients began active and active-assisted elbow and forearm movement the first day after operation. Indomethacin was taken the first day after open arthrolysis routinely.
Twelve patients were followed up for 14 - 18 months (averaged 15.8 months). At the latest follow-up, the mean arc of total motion was 120.8 degrees (100 degrees - 140 degrees ). Nine patients recovered the functional arc of 30 degrees - 130 degrees , and 10 patients extended to less than 10 degrees , and 4 patients could extend to 0 degrees . As for the 3 patients who suffered forearm rotation deficiency, the forearm rotation improved. The mean Mayo elbow performance score was 70.4 (50 - 90) before open arthrolysis, and 98.8 (85 - 100) after open arthrolysis. No patient was found to have signs of heterotopic ossification.
For the treatment of post-traumatic stiff elbow, with careful open arthrolysis and early active and active-assisted exercise we can get good results.
报告严重创伤后肘关节僵硬患者的切开松解方法及结果。
12例患者中，男性9例，女性3例，平均年龄32岁（16 - 47岁）。原发损伤包括7例单纯骨折、1例单纯脱位、2例骨折脱位和2例软组织损伤。伤后平均固定时间为3.3周（0 - 8周）。受伤至切开松解的平均时间为6.4个月（1 - 14个月）。切开松解前，总活动度平均为33.8度（0度 - 80度）。3例患者存在前臂旋转受限。4例采用后入路，2例采用内侧入路，6例采用内外侧联合入路。切除阻碍肘关节活动的组织，部分患者行近端桡尺关节松解。松解后，肘关节活动度可达0度 - 140度，存在前臂旋转受限的患者，旋前可达80度，旋后可达90度。尺神经移位并非常规操作。患者术后第一天开始主动及主动辅助的肘关节和前臂活动。切开松解术后第一天常规服用吲哚美辛。
12例患者随访14 - 18个月（平均15.8个月）。末次随访时，总活动度平均为120.8度（100度 - 140度）。9例患者恢复了30度 - 130度的功能活动度，10例患者伸直增加不到10度，4例患者伸直可达0度。对于3例存在前臂旋转受限的患者，前臂旋转功能有所改善。切开松解术前平均Mayo肘关节功能评分70.4（50 - 90），术后为98.8（85 - 100）。未发现患者有异位骨化迹象。
对于创伤后肘关节僵硬患者，通过仔细的切开松解及早期主动和主动辅助锻炼可取得良好效果。
