Blauth M, Haas N P, Südkamp N P, Happe T
Unfallchirurgische Klinik, Medizinische Hochschule Hannover.
Orthopade. 1990 Nov;19(6):332-42.
Intra- and periarticular fractures about the elbow joint are treated with open reduction and internal fixation. This allows early functional after-treatment. Nevertheless, the range of motion remains more or less unsatisfactory. In these cases open arthrolysis provides a considerable improvement in joint function. We therefore recommend this operation when the hardware is removed about 9 months after the accident. The reasons for post-traumatic contracture of the elbow could be intrinsic such as interposed fragments, intra-articular adhesions, incongruity of the articular surfaces--or extrinsic--like contractures of the capsule and ligaments, adhesions of different layers, ectopic bone formations. In most cases a combination of both can be found. Important conditions for successful arthrolysis are mostly intact joint surfaces, failure of all conservative efforts to improve the arc of motion, a motivated patient who understands clearly the risks and benefits that could reasonably be expected by the operative procedure and rehabilitation and, last but not least, a skilled, experienced surgeon. The choice of the approach depends on the main location of the post-traumatic changes and on previous incisions. Osteotomy of the radial epicondyle gives a much better view of the joint and should be performed whenever necessary. The exact course of the operation may not be standardized. The main point is to remove scarred adhesions and bony irregularities. An individually modified rehabilitation program is as important as the operative procedure itself to achieve the best results possible. In general, the exercises should not cause pain. In the first few days plaster casts in flexion and extension are used. Physiotherapy is supported by CPM machines as early as possible. Patients must be prepared with the help of drugs and the application of ice bags. Even after months improvement of motion can be obtained. In a retrospective follow-up study, 125 out of 168 patients with arthrolysis of the elbow joint were reviewed. Most patients sustained a fracture of the distal humerus. In 77%, the results were graded as very good, good or satisfactory, i.e., the average relative improvement amounted to at least 40% according to the criteria of W. Blauth. Patients with very severe (preoperative ROM 0-30 degrees) and severe (preoperative ROM 30-60 degrees) contractures profited more (relative improvement 60%) than the others (relative improvement 45%). Overall, the average arc of total motion increased 49 degrees; the relative improvement of motion increased by 58%.
肘关节周围的关节内和关节周围骨折采用切开复位内固定治疗。这使得早期功能后处理成为可能。然而，活动范围或多或少仍不尽人意。在这些情况下，开放性关节松解术可显著改善关节功能。因此，我们建议在事故发生约9个月后取出内固定装置时进行此手术。创伤后肘关节挛缩的原因可能是内在的，如嵌入的碎骨片、关节内粘连、关节面不平整，或者是外在的，如关节囊和韧带挛缩、不同层次的粘连、异位骨形成。在大多数情况下，可以发现两者兼而有之。成功进行关节松解术的重要条件大多是关节面基本完整、所有改善活动弧度的保守治疗均告失败、患者有积极性且清楚了解手术及康复过程中可能合理预期的风险和益处，最后但同样重要的是，要有一位技术娴熟、经验丰富的外科医生。手术入路的选择取决于创伤后改变的主要部位以及既往的手术切口。桡骨小头截骨术能更好地显露关节，必要时应进行。手术的确切步骤可能无法标准化。关键在于清除瘢痕粘连和骨质不平整。制定个性化的改良康复计划与手术本身同样重要，以尽可能取得最佳效果。一般来说，锻炼不应引起疼痛。最初几天使用屈伸石膏固定。尽早使用持续被动运动（CPM）机辅助物理治疗。必须借助药物和使用冰袋让患者做好准备。即使数月后仍可获得活动度的改善。在一项回顾性随访研究中，对168例肘关节松解术患者中的125例进行了复查。大多数患者为肱骨远端骨折。77%的患者结果评定为非常好、好或满意，即根据W. 布劳特的标准，平均相对改善至少达到40%。术前活动范围非常严重（0 - 30度）和严重（30 - 60度）挛缩的患者比其他患者获益更多（相对改善60%）（相对改善45%）。总体而言，总活动平均弧度增加了49度；活动度的相对改善增加了58%。
