Khelil Khaled, Znagui Talel, Khezami Mounira, Achouri Mohamed, Hamdi Mounir, Nouisri Lotfi
Service de Chirurgie Orthopédique et Traumatologique, Hôpital Militaire Principal d'Instruction de Tunis, Tunisie.
Pan Afr Med J. 2019 Nov 6;34:131. doi: 10.11604/pamj.2019.34.131.16685. eCollection 2019.
Neurogenic paraosteoarthropathies are ectopic ossifications which develop near the joints. They are a process of neo-ectopic osteogenesis occurring after central or peripheral neurological lesions, in some types of comas (oxygen carbon intoxication, prolonged sedation) and following peripheral traumas including burns. They inolve almost exclusively the large proximal joints of the limbs. Elbow is the second area of involvment. The purpose of our study was to analyze the results of surgical arthrolysis in 37 patients with elbow stiffness due to neurogenic osteoarthropathy of the elbow. We conducted a retrospective study of 35 patients and 37 elbows over a 25-year period. Preoperative assessment included clinical and radiological examination. Since 2003 the patients had undergone systematic elbow arthroscopy. The gold standard surgical treatment was arthrolysis. All patients underwent functional rehabilitation protocol. Outcomes were analyzed after a mean 5-year follow-up period (6 months - 10 years). Neurogenic paraosteoarthropathy was caused by head injury with coma in 58.8% of cases. Preoperative assessment showed bending stiffness in the majority of cases (88%), severe or very severe in 64.7% of cases. Intraoperatively functional elbow range of motion from -30° to 130° was obtained in 61.7% of cases and in 41% of cases in the long term. Ulnar nerve liberation was satisfactory in 92% of cases. No postoperative instability of the elbow was reported. Two patients with definitive neurological lesions had osteoma recurrence. The results were equivalent regardless surgical delay. Surgical arthrolysis is an effective treatment for neurogenic osteomas of the elbow.
神经源性骨关节病是在关节附近发生的异位骨化。它们是在中枢或周围神经损伤后、某些类型的昏迷（一氧化碳中毒、长期镇静）以及包括烧伤在内的周围创伤后发生的新异位骨生成过程。它们几乎仅累及四肢的大近端关节。肘部是第二个受累部位。我们研究的目的是分析37例因肘部神经源性骨关节病导致肘部僵硬的患者进行手术关节松解术的结果。我们对35例患者和37个肘部进行了为期25年的回顾性研究。术前评估包括临床和放射学检查。自2003年以来，患者接受了系统性肘关节镜检查。金标准手术治疗是关节松解术。所有患者均接受功能康复方案。在平均5年的随访期（6个月至10年）后分析结果。58.8%的病例中神经源性骨关节病由头部受伤伴昏迷引起。术前评估显示大多数病例（88%）存在屈曲僵硬，64.7%的病例为重度或极重度。术中61.7%的病例获得了从-30°到130°的功能性肘关节活动范围，长期来看这一比例为41%。92%的病例尺神经松解效果满意。未报告术后肘关节不稳定情况。两名有明确神经损伤的患者出现骨瘤复发。无论手术延迟情况如何，结果相当。手术关节松解术是治疗肘部神经源性骨瘤的有效方法。
