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关节镜联合小切口 Outerbridge-Kashiwagi 手术治疗肘关节炎的临床疗效。

Clinical outcomes of a combined arthroscopic and mini-open Outerbridge-Kashiwagi procedure for elbow osteoarthritis.

机构信息

Department of Emergency, Chinese PLA General Hospital, Haidian District, Beijing, China.

Department of Orthopedics, Chinese PLA General Hospital, Haidian District, Beijing, China.

出版信息

J Shoulder Elbow Surg. 2020 Dec;29(12):2646-2653. doi: 10.1016/j.jse.2020.05.007. Epub 2020 Jun 9.

Abstract

BACKGROUND

To evaluate the short-term clinical outcomes of a modified Outerbridge-Kashiwagi (O-K) procedure in the treatment of elbow osteoarthritis.

METHODS

Between January 2012 and December 2016, 27 patients with elbow osteoarthritis were treated with a modified O-K procedure combining mini-open and arthroscopic technique in our institution. All patients with primary osteoarthritis and post-traumatic degenerative osteoarthritis of the elbow were included in the study if they had undergone the modified O-K procedure. Clinical outcomes were assessed using the visual analog scale (VAS), degree of flexion, extension loss, arc of motion, Mayo Elbow Performance Score (MEPS), and radiographs.

RESULTS

Twenty-five patients with a mean age of 47.2 years (range, 21-69 years) at surgery were followed up for a mean of 54.5 months (range, 27-86 months). The VAS improved from 8.0 ± 1.4 (range, 6-10) preoperatively to 1.3 ± 1.1 (range, 0-3) at the final follow-up (P < .001), degree of flexion from 115.2° ± 12.0° (range, 90°-135°) to 130.6° ± 6.3° (range, 120°-140°) (P < .001), extension loss from 31.2° ± 15.0° (range, 10°-60°) to 10.2° ± 7.7° (range, 0°-30°) (P < .001), arc of motion from 84.0° ± 18.8° (range, 55°-120°) to 120.4° ± 9.3° (range, 105°-135°) (P < .001), and MEPS from 55.8 ± 8.1 (range, 40-70) to 88.4 ± 7.2 (range, 70-100) (P < .001). Radiographs at the final follow-up showed that 9 patients (36%) had significant recurrence of bone formation within the fenestration of the olecranon fossa. One patient developed delayed-onset ulnar neuropathy, with only slight numbness in the ulnar nerve distribution 6 months after surgery.

CONCLUSIONS

The modified O-K procedure is safe and effective in pain relief and function restoration in patients with elbow osteoarthritis.

摘要

背景

评估改良 Outerbridge-Kashiwagi(O-K)手术治疗肘关节炎的短期临床效果。

方法

2012 年 1 月至 2016 年 12 月,我院采用改良 O-K 手术(结合小切口和关节镜技术)治疗 27 例肘关节炎患者。所有患者均为原发性骨关节炎和创伤后退行性肘关节炎,均接受改良 O-K 手术。采用视觉模拟评分(VAS)、屈曲度、伸展丧失度、活动弧、 Mayo 肘功能评分(MEPS)和影像学评估临床疗效。

结果

25 例患者平均年龄 47.2 岁(21-69 岁),平均随访 54.5 个月(27-86 个月)。VAS 评分由术前 8.0±1.4(6-10)改善至末次随访时的 1.3±1.1(0-3)(P<0.001),屈曲度由术前 115.2°±12.0°(90°-135°)改善至 130.6°±6.3°(120°-140°)(P<0.001),伸展丧失度由术前 31.2°±15.0°(10°-60°)改善至 10.2°±7.7°(0°-30°)(P<0.001),活动弧由术前 84.0°±18.8°(55°-120°)改善至 120.4°±9.3°(105°-135°)(P<0.001),MEPS 评分由术前 55.8±8.1(40-70)改善至 88.4±7.2(70-100)(P<0.001)。末次随访时 X 线片显示,9 例(36%)患者鹰嘴窝开窗处有明显骨形成复发。1 例患者发生迟发性尺神经病变,术后 6 个月仅出现轻微的尺神经分布区麻木。

结论

改良 O-K 手术治疗肘关节炎安全有效,可缓解疼痛,恢复功能。

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