Department of Orthopaedics and Traumatology, Mauriziano Umberto I Hospital, University of Turin Medical School, Largo Turati 62, Turin 10128, Italy.
J Bone Joint Surg Am. 2013 Aug 7;95(15):1373-81. doi: 10.2106/JBJS.K.00972.
A major factor limiting the use of elbow arthroscopy for contracture release is concern regarding nerve injury. The purpose of this report is to document the risk of nerve injury in a large series of arthroscopic contracture releases utilizing a safety-driven strategy.
A series of 502 arthroscopic elbow contracture releases (including 388 osteocapsular arthroplasties) performed in 464 patients by one surgeon was reviewed retrospectively. The safety-driven step-wise strategy had been carried out in a standardized sequence: (1) Get In and Establish a View, (2) Create a Space in Which to Work, (3) Bone Removal, and (4) Capsulectomy. Neurologic complications were assessed and were followed until resolution.
No patient had a permanent nerve injury. Twenty-four patients (5%) had a transient nerve injury, associated with prolonged tourniquet time, cutaneous dysesthesia attributed to open incisions, simultaneous ulnar nerve transposition, or retractor use. All nerve deficits resolved after one day to twenty-four months, with one patient lost to follow-up.
Utilizing the technique described, arthroscopic contracture release and debridement of the elbow was performed with a low risk of nerve injury.
Therapeutic level III. See instructions for authors for a complete description of levels of evidence.
限制肘关节炎镜下挛缩松解术应用的一个主要因素是对神经损伤的担忧。本报告的目的是记录在使用安全驱动策略的大量肘关节炎镜下挛缩松解术中神经损伤的风险。
对一名外科医生进行的 464 例患者的 502 例肘关节炎镜下挛缩松解术（包括 388 例骨囊状关节成形术）进行回顾性分析。安全驱动的逐步策略已按标准化顺序进行：（1）进入并建立视野，（2）创建工作空间，（3）骨切除，和（4）囊切除术。评估神经并发症，并持续随访直至解决。
无患者发生永久性神经损伤。24 例（5%）患者发生短暂性神经损伤，与长时间使用止血带、开放性切口引起的皮肤感觉异常、同时行尺神经转位或牵开器使用有关。所有神经功能缺陷在 1 天至 24 个月内得到解决，1 例患者失访。
使用描述的技术，进行肘关节炎镜下挛缩松解术和清创术，神经损伤风险较低。
治疗性 III 级。有关证据水平的完整描述，请参见作者指南。
