Iyidobi Emmanuel C, Nwadinigwe Cajetan U, Ekwunife Remigus T, Anyaehie Udo E, Omolade Lasebikan A, Ede Osita, Okeke Valentine
Department of Orthopaedics and Trauma, National Orthopaedic Hospital, HA7 4LP Enugu, Nigeria.
SICOT J. 2020;6:8. doi: 10.1051/sicotj/2020006. Epub 2020 May 5.
Post-traumatic elbow stiffness (PTES) results in severe interference with the activities of daily living (ADL), affecting mainly young people. Total elbow arthroplasty (TEA) is relatively contraindicated in the young patient and arthrodesis is poorly tolerated. Interposition elbow arthroplasty (IEA) improves the range of motion (ROM) buying time for future reconstructive surgery. While the fascia lata remains the most common material used in IEA, the triceps fascia is a native vascularized tissue, and it does not require a separate incision to harvest. To our knowledge, there are no published studies on the use of this technique of IEA.
Sixteen patients with post-traumatic elbow stiffness had IEA with the triceps fascia between January 2009 and January 2017. The ROM was assessed pre-operatively and post-operatively at the 6th and the 24th week. The researchers also evaluated the functional outcome with the Mayo Elbow Performance Score (MEPS) at the 24th week. The data were analysed with the software IBM SPSS Version 20.
Nine males and seven females had IEA with the triceps fascia. The mean age of the subjects was 22.8 years (SD = 6.39). The median duration of the stiffness was eight months (range: 2-168 months). Fall was the most frequent cause of post-traumatic elbow stiffness, and the non-dominant side was more frequently involved. Fourteen patients had an intervention at the native bone setters before presentation to the hospital. The mean elbow ROM increased from 16.4° pre-operatively to 97.2° at the 24th week (p < 0.001), while the mean MEPS improved from 42.5° pre-operatively to 81.2° post-operatively (p < 0.001).
The triceps fascia flap provides an excellent alternative to the fascia lata for IEA without the complications of the donor site morbidity.
创伤后肘关节僵硬（PTES）严重干扰日常生活活动（ADL），主要影响年轻人。全肘关节置换术（TEA）在年轻患者中相对禁忌，而关节融合术耐受性较差。间置式肘关节置换术（IEA）可改善活动范围（ROM），为未来的重建手术争取时间。虽然阔筋膜仍是IEA中最常用的材料，但肱三头肌筋膜是一种自身带血管的组织，无需单独切口获取。据我们所知，尚无关于使用这种IEA技术的已发表研究。
2009年1月至2017年1月期间，16例创伤后肘关节僵硬患者接受了肱三头肌筋膜间置式肘关节置换术。术前以及术后第6周和第24周评估ROM。研究人员还在第24周时用梅奥肘关节功能评分（MEPS）评估功能结果。数据用IBM SPSS 20版软件进行分析。
9例男性和7例女性接受了肱三头肌筋膜间置式肘关节置换术。受试者的平均年龄为22.8岁（标准差=6.39）。僵硬的中位持续时间为8个月（范围：2 - 168个月）。跌倒为创伤后肘关节僵硬最常见的原因，非优势侧更常受累。14例患者在到医院就诊前曾在当地接骨师处接受过治疗。肘关节平均ROM从术前的16.4°增加到第24周时的97.2°（p < 0.001），而平均MEPS从术前的42.5°提高到术后的81.2°（p < 0.001）。
肱三头肌筋膜瓣为IEA提供了替代阔筋膜的极佳选择，且无供区并发症。
