Kulkarni G S, Kulkarni V S, Shyam A K, Kulkarni R M, Kulkarni M G, Nayak P
Postgraduate Institute of Swasthiyog Pratishthan, Miraj, Maharashtra, India.
J Bone Joint Surg Br. 2010 Jan;92(1):92-7. doi: 10.1302/0301-620X.92B1.22241.
Arthrolysis and dynamic splinting have been used in the treatment of elbow contractures, but there is no standardised protocol for treatment of severe contractures with an arc of flexion < 30 degrees . We present our results of radical arthrolysis with twin incisions with the use of a monolateral hinged fixator to treat very severe extra-articular contracture of the elbow. This retrospective study included 26 patients (15 males and 11 females) with a mean age of 30 years (12 to 60). The mean duration of stiffness was 9.1 months (5.4 to 18) with mean follow-up of 5.2 years (3.5 to 9.4). The mean pre-operative arc of movement was 15.6 degrees (0 degrees to 30 degrees ), with mean pre-operative flexion of 64.1 degrees (30 degrees to 120 degrees ) and mean pre-operative extension of 52.1 degrees (10 degrees to 90 degrees ). Post-operatively the mean arc improved to 102.4 degrees (60 degrees to 135 degrees ), the mean flexion improved to 119.1 degrees (90 degrees to 140 degrees ) and mean extension improved to 16.8 degrees (0 degrees to 30 degrees ) (p < 0.001). The Mayo elbow score improved from a mean of 45 (30 to 65) to 89 (75 to 100) points, and 13 had excellent, nine had good, three had fair and one had a poor result. We had one case of severe instability and one wound dehiscence which responded well to treatment. One case had deep infection with poor results which responded well to treatment. Our findings indicate that this method is very effective in the treatment of severe elbow contracture; however, a randomised controlled study is necessary for further evaluation.
关节松解术和动力夹板已用于治疗肘关节挛缩，但对于屈曲弧度小于30度的严重挛缩，尚无标准化的治疗方案。我们展示了采用双切口根治性关节松解术并使用单侧铰链固定器治疗肘关节非常严重的关节外挛缩的结果。这项回顾性研究纳入了26例患者（15例男性和11例女性），平均年龄30岁（12至60岁）。平均僵硬持续时间为9.1个月（5.4至18个月），平均随访5.2年（3.5至9.4年）。术前平均活动弧度为15.6度（0度至30度），术前平均屈曲度为64.1度（30度至120度），术前平均伸展度为52.1度（10度至90度）。术后平均弧度改善至102.4度（60度至135度），平均屈曲度改善至119.1度（90度至140度），平均伸展度改善至16.8度（0度至30度）（p<0.001）。梅奥肘关节评分从平均45分（30至65分）提高到89分（75至100分），13例结果优秀，9例良好，3例尚可，1例结果差。我们有1例严重不稳定和1例伤口裂开，经治疗后反应良好。1例深部感染，结果较差，但经治疗后反应良好。我们的研究结果表明，这种方法在治疗严重肘关节挛缩方面非常有效；然而，需要进行随机对照研究以作进一步评估。
