Orthopaedic Hand and Upper Extremity Service, Massachusetts General Hospital, 55 Fruit Street, Boston, MA 02114, USA.
J Bone Joint Surg Am. 2010 Sep 15;92(12):2187-95. doi: 10.2106/JBJS.H.01594.
Operative contracture release may improve motion of a posttraumatic stiff elbow. In this study, we tested the hypothesis that improvement in ulnohumeral motion after elbow contracture release leads to improvement in general health status and decreases upper-extremity-specific disability.
Twenty-three patients with posttraumatic loss of ≥30° of elbow flexion or extension who elected to have an open elbow capsulectomy completed the Disabilities of the Arm, Shoulder and Hand questionnaire (DASH) and the Short Form-36 (SF-36) preoperatively and at least one year postoperatively. Pain was measured with use of the American Shoulder and Elbow Surgeons (ASES) Elbow Evaluation instrument. Four patients underwent additional, subsequent procedures to address residual elbow stiffness.
One patient who needed several additional procedures, including a total elbow arthroplasty, was considered to have had a failure of the operative contracture release and was excluded from the analysis; this left twenty-two patients in the study. On the average, the arc of flexion and extension improved from 51° preoperatively to 106° postoperatively; the DASH score, from 38 points to 18 points; the SF-36 Physical Component Summary (PCS) score, from 39 points to 49 points (all p < 0.05); and the SF-36 Mental Component Summary (MCS) score, from 49 points to 54 points (p < 0.05). There was no significant correlation between the improvement in the arc of flexion and extension and the improvement in the DASH (p = 0.53), PCS (p = 0.73), or MCS (p = 0.41) score. There also was no correlation between the final arc of flexion and extension and the final DASH score (p = 0.39 for the total score, p = 0.52 for the PCS score, and p = 0.42 for the MCS score).
Health status and disability scores improve after open elbow contracture release, but the improvements do not correlate with the improvement in elbow motion. Among multiple objective and subjective factors, pain was a strong predictor of the final general health status and arm-specific disability.
手术性挛缩松解术可能改善创伤后僵硬肘部的活动度。在本研究中，我们验证了如下假说，即肘挛缩松解术后尺肱活动度的改善会导致总体健康状况的改善，并减少上肢特定的残疾。
23 例创伤后丧失 30°以上肘部屈伸活动度的患者选择行开放肘囊切除术，在术前和术后至少 1 年时分别使用上肢残疾问卷（DASH）和健康调查简表 36 项（SF-36）进行评估。疼痛使用美国肩肘外科医师协会（ASES）肘部评估工具进行测量。4 例患者接受了进一步的后续手术以解决残余的肘部僵硬。
1 例患者需要进行多次额外手术，包括全肘置换术，被认为是手术性挛缩松解术的失败病例，因此被排除在分析之外；这使得 22 例患者进入研究。平均而言，屈伸活动度从术前的 51°改善到术后的 106°；DASH 评分从 38 分改善到 18 分；SF-36 生理健康总分（PCS）从 39 分改善到 49 分（均 p < 0.05）；SF-36 心理健康总分（MCS）从 49 分改善到 54 分（p < 0.05）。屈伸活动度的改善与 DASH（p = 0.53）、PCS（p = 0.73）或 MCS（p = 0.41）评分的改善之间没有显著相关性。最终的屈伸活动度与最终的 DASH 评分之间也没有相关性（总分为 p = 0.39，PCS 为 p = 0.52，MCS 为 p = 0.42）。
开放性肘挛缩松解术后健康状况和残疾评分均得到改善，但改善与肘部活动度的改善无关。在多个客观和主观因素中，疼痛是总体健康状况和上肢特定残疾的强有力预测因素。
