Hattori Yasunori, Doi Kazuteru, Sakamoto Soutetsu, Hoshino Shushi, Dodakundi Chaitanya
Department of Orthopedic Surgery, Ogori Daiichi General Hospital, Ogori, Yamaguchi, Japan.
J Hand Surg Am. 2011 Oct;36(10):1652-8. doi: 10.1016/j.jhsa.2011.07.018. Epub 2011 Aug 27.
Debridement arthroplasty combined with capsulectomy for primary osteoarthritis of the elbow is a useful procedure to relieve pain and increase mobility. We have used a medial trans-flexor approach without tendon detachment for debridement arthroplasty of the elbow and evaluated the outcome of this procedure.
Thirty-one elbows with primary osteoarthritis in 31 patients treated with debridement arthroplasty were available for follow-up at a mean of 19 ± 7 months. Twenty-four patients were men, and 7 were women. The mean age at the time of surgery was 59 ± 10 years. All elbows were painful only at the end points of motion. The anterior compartment of the elbow was accessed by splitting of the pronator flexor muscle group without tendon detachment. Routine anterior subcutaneous transposition of the ulnar nerve was used in all elbows. In 10 elbows, osteophytes or loose osseous bodies from the lateral compartment were removed through an additional lateral approach.
Twenty-three elbows had no pain, and 8 elbows had mild pain. The mean preoperative limitation of extension decreased from 29° ± 9° to 15° ± 9° and the mean preoperative flexion increased from 100° ± 10° to 126° ± 7°. Thus, the mean arc of elbow motion increased by 40° ± 13°. The mean Mayo Elbow Performance Score was 94 ± 7 compared with 60 ± 5 before surgery. The results were excellent for 22 elbows and good for 9. Hematomas developed in 3 elbows, but they did not require surgical drainage.
Debridement arthroplasty using the medial trans-flexor approach without tendon detachment yields satisfactory short-term clinical results. This approach is associated with a low rate of complications and is safe and effective for the treatment of primary osteoarthritis of the elbow.
TYPE OF STUDY/LEVEL OF EVIDENCE: Therapeutic IV.
清创关节成形术联合关节囊切除术治疗原发性肘关节骨关节炎是一种缓解疼痛和增加活动度的有效方法。我们采用了不切断肌腱的内侧经屈肌入路进行肘关节清创关节成形术，并评估了该手术的效果。
31例接受清创关节成形术治疗原发性骨关节炎的患者的31个肘关节可进行随访，平均随访时间为19±7个月。其中男性24例，女性7例。手术时的平均年龄为59±10岁。所有肘关节仅在活动终点时疼痛。通过劈开旋前屈肌肌群且不切断肌腱来显露肘关节前侧间隙。所有肘关节均常规进行尺神经皮下前置。10个肘关节通过额外的外侧入路切除外侧间室的骨赘或游离骨块。
23个肘关节无疼痛，8个肘关节有轻度疼痛。术前平均伸直受限角度从29°±9°降至15°±9°，术前平均屈曲角度从100°±10°增至126°±7°。因此，肘关节平均活动弧度增加了40°±13°。Mayo肘关节功能评分术前平均为60±5分，术后为94±7分。22个肘关节效果优秀，9个肘关节效果良好。3个肘关节出现血肿，但无需手术引流。
采用不切断肌腱的内侧经屈肌入路进行清创关节成形术可获得满意的短期临床效果。该入路并发症发生率低，治疗原发性肘关节骨关节炎安全有效。
研究类型/证据水平：治疗性IV级。
