1The CORE Institute, Phoenix, Arizona 2Department of Orthopaedic Surgery and Rehabilitation, University of Nebraska Medical Center, Omaha, Nebraska 3Scranton Orthopaedic Specialists, Dickson City, Pennsylvania.
J Bone Joint Surg Am. 2017 Nov 1;99(21):1859-1865. doi: 10.2106/JBJS.16.00715.
Elbow contractures can cause functional limitation, and treatment can be challenging. The purpose of this article is to describe a novel technique that releases posttraumatic elbow contractures through an olecranon osteotomy and report the outcomes.
Thirty-five patients with refractory posttraumatic elbow contracture who underwent an olecranon osteotomy-facilitated elbow release (OFER) procedure were included in the study. The average patient age was 39.5 years (range, 18 to 63 years), and the mean duration of follow-up was 37.2 months (range, 24 to 72 months). Preoperative and postoperative data included age, sex, cause of contracture, previous surgical procedures, active elbow range of motion, Disabilities of the Arm, Shoulder and Hand (DASH) scores, visual analog scale pain scores, and radiographs. Intraoperative tourniquet time and complications were recorded.
The mean preoperative elbow motion arc was 33° (51° to 84° of flexion). Postoperatively, the motion arc improved significantly (p < 0.001) to 110° (16° to 126° of flexion). The mean visual analog pain scale score improved from 6.3 preoperatively to 1.4 at the time of follow-up (p < 0.001). The mean DASH score improved from 57.5 preoperatively to 10.9 postoperatively (p < 0.001). The maximal improvement in the motion arc occurred at a mean of 8.7 weeks. There was 1 postoperative ulnar neurapraxia that resolved spontaneously. The intraoperative tourniquet time averaged 27 minutes (range, 18 to 45 minutes). The average time until radiographic evidence of union of the olecranon osteotomy site was 6.6 weeks (range, 5.7 to 7.7 weeks).
The OFER is a safe and effective means of treating posttraumatic elbow contractures, and is an alternative to traditional open or arthroscopic techniques.
Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.
肘挛缩可导致功能受限，治疗具有挑战性。本文旨在介绍一种通过尺骨鹰嘴截骨松解外伤性肘挛缩的新方法，并报告其结果。
35 例难治性外伤性肘挛缩患者行鹰嘴截骨辅助肘松解术（OFER）。患者平均年龄 39.5 岁（18 岁至 63 岁），平均随访时间 37.2 个月（24 个月至 72 个月）。术前和术后数据包括年龄、性别、挛缩原因、既往手术、主动肘活动度、上肢残疾问卷（DASH）评分、视觉模拟疼痛评分和影像学。记录术中止血带时间和并发症。
术前平均肘运动弧为 33°（51°至 84°屈曲）。术后运动弧显著改善（p<0.001）至 110°（16°至 126°屈曲）。术前视觉模拟疼痛评分平均为 6.3，随访时为 1.4（p<0.001）。术前 DASH 评分平均为 57.5，术后为 10.9（p<0.001）。运动弧最大改善发生在平均 8.7 周。术后 1 例出现尺神经麻痹，自行缓解。术中止血带时间平均为 27 分钟（18 分钟至 45 分钟）。尺骨鹰嘴截骨愈合的平均时间为 6.6 周（5.7 周至 7.7 周）。
OFER 是治疗外伤性肘挛缩的一种安全有效的方法，是传统开放或关节镜技术的替代方法。
治疗水平 IV。有关证据水平的完整描述，请参见作者指南。
