College of Medicine Chattanooga, University of Tennessee, Chattanooga, TN.
Department of Orthopaedics, University of Alabama-Birmingham, Birmingham, AL.
J Orthop Trauma. 2018 Aug;32(8):e304-e308. doi: 10.1097/BOT.0000000000001222.
Evaluate the safety and efficacy of manipulation under anesthesia (MUA) for posttraumatic elbow stiffness.
Retrospective, case series.
Single institution; level 1 trauma center.
PATIENTS/PARTICIPANTS: Chart review of 45 patients over a 10-year period treated with MUA for posttraumatic elbow stiffness after elbow injuries treated both operatively and nonoperatively.
None.
Change in total flexion arc pre- to postmanipulation; time to manipulation; complications.
Average time from most recent surgical procedure or date of injury to MUA was 115 days. Average premanipulation flexion arc was 57.9 degrees; average flexion arc at the final follow-up was 83.7 degrees. The improvement in elbow flexion arc of motion was statistically significant (P < 0.001). Post hoc analysis of the data revealed 2 distinct groups: 28 patients who underwent MUA within 3 months of their most recent surgical procedure (early manipulation), and 17 patients who underwent MUA after 3 months (late manipulation). Average improvement in elbow flexion arc in the early MUA group was 38.3 degrees (P < 0.001); improvement in the late MUA group was 3.1 degree. Comparison of improvement between the early and late MUA groups found a significant difference (P < 0.001) in mean flexion arc improvement from premanipulation to postmanipulation, favoring the early group. One patient had a complication directly attributable to MUA. Nineteen patients required additional procedures on the injured extremity after MUA.
MUA is a safe and effective adjunct to improving motion in posttraumatic elbow stiffness when used within 3 months from the original injury or time of surgical fixation. After 3 months, MUA does not reliably increase elbow motion.
Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.
评估麻醉下手法松解术（MUA）治疗创伤后肘僵硬的安全性和有效性。
回顾性病例系列研究。
单机构；1 级创伤中心。
患者/参与者：对 10 年间接受 MUA 治疗创伤后肘僵硬的 45 例患者的病历进行回顾，这些患者的肘部损伤均经手术和非手术治疗。
无。
手法松解前后总屈曲弧的变化；手法松解时间；并发症。
从最近一次手术或受伤日期到 MUA 的平均时间为 115 天。平均术前屈曲弧为 57.9°；最终随访时的平均屈曲弧为 83.7°。肘关节活动度的屈曲弧改善具有统计学意义（P < 0.001）。对数据的事后分析显示有 2 个明显不同的组：28 例患者在最近一次手术 3 个月内接受 MUA（早期手法松解），17 例患者在 3 个月后接受 MUA（晚期手法松解）。早期 MUA 组的平均肘关节屈曲弧改善 38.3°（P < 0.001）；晚期 MUA 组改善 3.1°。早期和晚期 MUA 组之间的改善比较发现，从术前到术后的平均屈曲弧改善有显著差异（P < 0.001），早期组更优。1 例患者出现与 MUA 直接相关的并发症。19 例患者在 MUA 后对受伤肢体进行了其他手术。
MUA 是治疗创伤后肘僵硬的一种安全有效的方法，在原始损伤或手术固定后 3 个月内使用可改善运动功能。3 个月后，MUA 不能可靠地增加肘关节运动。
治疗性 IV 级。有关证据水平的完整描述，请参见作者指南。
