Mansat P, Bonnevialle N, Werner B
Centre Hospitalier Universitaire PURPAN, Place du Dr. Baylac, F-31059, Toulouse, France.
Orthopade. 2011 Apr;40(4):307-15. doi: 10.1007/s00132-010-1666-5.
Severe extrinsic elbow contracture can be treated effectively using elbow arthrolysis to obtain satisfactory results. Preoperative planing is of prime importance to evaluate joint involvement and to decide how to approach the capsule from the lateral or medial aspect of the elbow. Most of the time because of the extensive involvement of the periarticular tissue, a combined approach is usually preferred. It is a step-by-step procedure that must be adapted to the progressive gain of motion. The ulnar nerve must be identified systematically and often anteriorly transposed. Maximum gain of motion must be obtained at surgery because loss of elbow motion after surgery is common. Postoperative management must be closely followed static splint being preferable to active physiotherapy. Results of surgical arthrolysis for extrinsic stiffness is often satisfactory with an absolute gain in the flexion-extension arc between 30 and 60°.
严重的外在性肘关节挛缩可通过肘关节松解术有效治疗并获得满意结果。术前规划对于评估关节受累情况以及决定从肘关节外侧或内侧如何处理关节囊至关重要。大多数情况下，由于关节周围组织广泛受累，通常首选联合入路。这是一个循序渐进的过程，必须根据运动的逐步改善进行调整。必须系统地识别尺神经，且常需将其向前移位。手术时必须获得最大程度的运动改善，因为术后肘关节活动度丧失很常见。术后管理必须密切跟进，静态夹板固定优于主动物理治疗。手术松解外在性僵硬的结果通常令人满意，屈伸弧绝对增加30至60°。
