Department of Hand Surgery, Huashan Hospital, Fudan University, Shanghai, China.
Key Laboratory of Hand Reconstruction, Ministry of Health, Shanghai, China.
Orthop Surg. 2020 Oct;12(5):1464-1470. doi: 10.1111/os.12787. Epub 2020 Oct 4.
To evaluate the effectiveness of arthroscopic management of posttraumatic elbow stiffness due to soft tissue problems.
A retrospective review of 30 consecutive arthroscopic elbow releases for posttraumatic stiff elbow from November 2011 to December 2019 was conducted. Stiff elbows with bony problems, such as heterotopic ossification, intraarticular nonunion or malunion, and cartilage lesions were excluded from this study. Contracture and adhesion of soft tissue around the elbow were identified. Surgical treatments included arthroscopic capsulectomy, ligaments and muscle release, and ulnar nerve release. The results were evaluated using the Mayo elbow performance score (MEPS) and range of motion of the elbow. Surgery-related complications were assessed.
Patients who underwent arthroscopic release were followed up for between 6 and 35 months, with a mean follow-up time of 10.1 months. The postoperative elbow ROM was 123.2° ± 19°, which was significantly different compared to the preoperative value of 68° ± 32°. In addition, the MEPS score improved from 71.2 ± 10.3 preoperatively to 93.7 ± 6.6 at the final follow-up, a mean improvement of 22.5 (range, 0-55; P < 0.05). Postoperative complications included five cases of prolonged drainage from the portal site, three transient nerve palsies, and one hematoma in the medial elbow.
With full recognition by the surgeon of the pathologic changes of the soft tissue around the elbow, arthroscopic release is usually safe and effective for posttraumatic elbow stiffness without symptomatic bony problems.
评估关节镜治疗软组织问题引起的创伤后肘僵硬的效果。
回顾性分析 2011 年 11 月至 2019 年 12 月连续 30 例创伤后肘僵硬的关节镜下松解术。本研究排除了有骨问题的僵硬肘部，如异位骨化、关节内骨不连或畸形愈合以及软骨损伤。确定肘部软组织的挛缩和粘连。手术治疗包括关节镜下囊切除术、韧带和肌肉松解术以及尺神经松解术。采用 Mayo 肘功能评分（MEPS）和肘活动度评估结果。评估手术相关并发症。
接受关节镜松解术的患者随访 6 至 35 个月，平均随访时间 10.1 个月。术后肘活动度为 123.2°±19°，与术前 68°±32°相比差异有统计学意义。此外，MEPS 评分从术前的 71.2±10.3 提高到最终随访时的 93.7±6.6，平均提高 22.5（范围为 0-55；P<0.05）。术后并发症包括 5 例引流管端口延长引流、3 例短暂性神经麻痹和 1 例内侧肘部血肿。
在外科医生充分认识肘部软组织病变的情况下，关节镜松解术通常是安全有效的，可用于治疗无症状性骨问题的创伤后肘僵硬。
