Ulmar B, Eschler A, Mittlmeier T
Abteilung für Unfall- und Wiederherstellungschirurgie, Chirurgische Klinik und Poliklinik, Universitätsmedizin Rostock, Schillingallee 35, 18057, Rostock, Deutschland.
Unfallchirurg. 2012 Aug;115(8):725-37; quiz 738. doi: 10.1007/s00113-012-2241-9.
According to the literature approximately 5% of all elbow injuries result in elbow stiffness. Following pathomorphological aspects elbow stiffness can be classified into intrinsic (intra-articular) and extrinsic (extra-articular) types. Mixed forms are common. Patient evaluation should include age, degree of stiffness, predisposition and anamnesis of professional and leisure time. Basic diagnostics for planning surgical treatment routinely include clinical evaluation, x-rays and computed tomography. Before indications for open arthrolysis of the elbow are given conservative treatment of more than 3 months should be performed. General indications for surgical treatment are pain, limitations in the range of motion and functional deficits. Contraindications are infections and severe general or psychological comorbidities. The optimal results of open elbow arthrolysis are a pain-free situation and freedom of movement of the elbow with retained strength and stability of the joint. Surgical approaches should be adapted to the individual joint pathology and should use previous approaches to avoid further soft tissue and/or joint trauma. For open arthrolysis of the elbow different approaches can be performed; however, the radial (lateral) combined with the ulnar (medial) approach is most common. Postsurgical procedures include physiotherapy, physical therapy, lymph drainage, bedding splints and continuous passive motion therapy. The results after open arthrolysis of the elbow are mainly influenced by the correct indications and patient selection. According to the literature the range of motion in flexion/extension improved on average 47° and functional scores increased significantly. In addition to general surgical complications the main complication after surgery was a deterioration of the range of motion. The total complication rate ranged from 0 to 30%. However, open arthrolysis of the elbow is a technically simple, safe and on average less complicated surgical procedure, which shows good results, if the indications are correct.
根据文献记载，所有肘部损伤中约5%会导致肘关节僵硬。从病理形态学角度来看，肘关节僵硬可分为内在（关节内）型和外在（关节外）型。混合型较为常见。患者评估应包括年龄、僵硬程度、易患因素以及职业和休闲时间的既往史。规划手术治疗的基本诊断常规包括临床评估、X线检查和计算机断层扫描。在给出肘关节开放性关节松解术的指征之前，应进行超过3个月的保守治疗。手术治疗的一般指征是疼痛、活动范围受限和功能缺陷。禁忌证为感染以及严重的全身或心理合并症。肘关节开放性关节松解术的最佳结果是无痛状态以及肘关节活动自如，同时保留关节的强度和稳定性。手术入路应根据个体关节病理情况进行调整，并应采用既往的入路以避免进一步的软组织和/或关节创伤。对于肘关节开放性关节松解术，可以采用不同的入路；然而，桡侧（外侧）联合尺侧（内侧）入路最为常见。术后程序包括物理治疗、体能治疗、淋巴引流、卧床夹板固定和持续被动运动治疗。肘关节开放性关节松解术后的结果主要受正确的指征和患者选择的影响。根据文献记载，屈伸活动范围平均改善47°，功能评分显著提高。除了一般的手术并发症外，术后的主要并发症是活动范围恶化。总并发症发生率在0%至30%之间。然而，肘关节开放性关节松解术是一种技术上简单、安全且平均并发症较少的手术操作，如果指征正确，可显示出良好的效果。
