Department of Traumatology and Orthopaedic Surgery, Adam Gruca Clinical Hospital, Center for Postgraduate Medical Education, Otwock, Poland.
Department of Neurosurgery, Military Institute of Medicine, ul. Szaserów 128, 04-141, Warsaw, Poland.
Int Orthop. 2020 May;44(5):911-918. doi: 10.1007/s00264-020-04494-0. Epub 2020 Feb 12.
The effect of open release of a post-traumatic elbow contracture on the stability of the joint has not been so far studied in vivo. Resection of elbow joint capsule, the key element of surgery, was reported to have no effect on the stability of cadaveric elbows. The joint capsule is yet known to participate in maintaining elbow stability as one of secondary stabilizers.
We assessed elbow joint laxity in 39 patients who underwent an open contracture release via the 'column procedure' described by B. Morrey and P. Mansat within the preceeding three to nine months. The measurements were taken with an apparatus designed particularly for this experiment according to the predetermined protocol. A preliminary part of the experiment showed that there was no significant difference between laxity of two elbow joints in healthy volunteers. Laxity of the operated elbows could be then compared with the contralateral joints.
Mean absolute difference of laxity between healthy and operated elbows was 1.55° (0.1°-4.1°, SD = 1.1) being significantly lower than 2°, p = 0.0056. The difference of the joint laxity between the operated and healthy elbows did not differ statistically significantly by more than 0.6° from the difference of the laxity of two healthy elbows and, therefore, is not clinically noticeable.
Our experiment confirmed that the 'column procedure' is a safe procedure which does not compromise the stability of the elbow joint.
目前尚未在体内研究创伤后肘挛缩开放松解对关节稳定性的影响。已报道手术的关键要素——切除肘关节囊对 cadaveric 肘部的稳定性没有影响。然而，关节囊作为次要稳定器之一，被认为参与维持肘部稳定性。
我们评估了 39 例患者的肘关节松弛度，这些患者在过去 3 至 9 个月内接受了 B. Morrey 和 P. Mansat 描述的“柱形手术”进行开放性挛缩松解。测量是根据预定方案使用专门为此实验设计的设备进行的。实验的初步部分表明，健康志愿者的两个肘关节松弛度之间没有显着差异。然后可以将手术侧肘关节的松弛度与对侧关节进行比较。
健康和手术侧肘关节松弛度之间的平均绝对差异为 1.55°（0.1°-4.1°，SD=1.1），显着低于 2°，p=0.0056。手术和健康肘关节之间的关节松弛度差异与两个健康肘关节之间的松弛度差异相差不超过 0.6°，因此在临床上并不明显。
我们的实验证实，“柱形手术”是一种安全的手术，不会影响肘关节的稳定性。
