Cai Jiangyu, Liu Jiazhi, Fan Cunyi
Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi. 2015 Jul;29(7):826-30.
To explore the effectiveness and safety of open arthrolysis combined with internal fixator removal for post-traumatic elbow stiffness.
A retrospective analysis was made on the data of 80 cases treated by open arthrolysis for elbow stiffness between January 2010 and December 2011. The patients were divided into 2 groups: no internal fixation group (group A, n = 39) and internal fixation group (group B, n = 41) according to whether they underwent internal fixator removal at the same time. No significant difference was found in age, gender, affected side, injury time, elbow rigidity grade, and severity of heterotopic ossification (HO) between 2 groups (P > 0.05) except for original injury type (P < 0.05). The effectiveness was evaluated by the occurrence of complications including ulnar nerve symptoms, HO recurrence and re-fracture, the elbow range of motion (ROM) and the Mayo elbow performance score (MEPS).
The mean follow-up duration was 15.7 months (range, 12-18 months) in group A and 16.1 months (range, 12-20 months) in group B. Ulnar nerve symptoms in 5 cases (12.8%) and HO reccurrence in 1 case (2.6%) occurred in group A, while ulnar nerve symptoms in 4 cases (9.8%), HO recurrence 1 case (2.4%), and refracture in 1 case (2.4%) occurred in group B. The incidence of each complication showed no significant difference between 2 groups (P > 0.05). Both the ROM and the MEPS at last follow-up increased significantly when compared with preoperative ones in 2 groups (P < 0.05). Besides, MEPS of group A was significantly higher than that of group B (t = 2.36, P = 0.02), but no significant difference was found in the ROM between 2 groups at last follow-up (t = 0.40, P = 0.69). Based on MEPS, the results were excellent in 16 cases, good in 16 cases, fair in 6 cases, and poor in 1 case in group A with an excellent and good rate of 82.1%; the results were excellent in 10 cases, good in 25 cases, fair in 4 cases, and poor in 2 cases in group B with an excellent and good rate of 85.4%. There was no significant difference in excellent and good rate between 2 groups (χ2 = 0.16, P = 0.69).
Open elbow arthrolysis combined with internal fixator removal for post-traumatic elbow stiffness is safe and effective. However, measures for prevention of re-fracture should always be taken into consideration.
探讨开放性关节松解术联合内固定取出术治疗创伤后肘关节僵硬的有效性和安全性。
回顾性分析2010年1月至2011年12月期间80例行开放性肘关节松解术治疗肘关节僵硬患者的资料。根据是否同期取出内固定物将患者分为2组：未行内固定组（A组，n = 39）和内固定组（B组，n = 41）。除原始损伤类型外，两组患者在年龄、性别、患侧、受伤时间、肘关节僵硬程度分级及异位骨化（HO）严重程度方面差异均无统计学意义（P > 0.05），而原始损伤类型差异有统计学意义（P < 0.05）。通过包括尺神经症状、HO复发和再骨折等并发症的发生情况、肘关节活动范围（ROM）及Mayo肘关节功能评分（MEPS）来评估疗效。
A组平均随访时间为15.7个月（范围12 - 18个月），B组为16.1个月（范围12 - 20个月）。A组发生尺神经症状5例（12.8%），HO复发1例（2.6%）；B组发生尺神经症状4例（9.8%），HO复发1例（2.4%），再骨折1例（2.4%）。两组各并发症发生率差异无统计学意义（P > 0.05）。两组末次随访时的ROM和MEPS均较术前显著增加（P < 0.05）。此外，A组的MEPS显著高于B组（t = 2.36，P = 0.02），但两组末次随访时的ROM差异无统计学意义（t = 0.40，P = 0.69）。根据MEPS评估，A组优16例，良16例，可6例，差1例，优良率为82.1%；B组优10例，良25例，可4例，差2例，优良率为85.4%。两组优良率差异无统计学意义（χ2 = 0.16，P = 0.69）。
开放性肘关节松解术联合内固定取出术治疗创伤后肘关节僵硬安全有效。然而，应始终考虑预防再骨折的措施。
