Biomechanical Laboratory of Orthopaedic Surgery Department, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China.
Department of Orthopaedics, Huadong Hospital Affiliated to Fudan University, Shanghai, China.
Orthop Surg. 2023 Aug;15(8):2102-2109. doi: 10.1111/os.13714. Epub 2023 Apr 13.
Open arthrolysis (OA) combined with hinged external fixator (HEF) is a promising surgical option for patients with elbow stiffness. This study aimed to investigate elbow kinematics and function following a combined treatment with OA and HEF in elbow stiffness cases.
Patients treated with OA with or without HEF due to elbow stiffness were recruited between August 2017 and July 2019. Elbow flexion-extension motion and function (Mayo elbow performance scores, MEPS) were recorded and compared between patients with and without HEF during a 1-year follow-up period. Additionally, those with HEF were assessed by dual fluoroscopy at week 6 postoperatively. Flexion-extension and varus-valgus motions, as well as ligament insertion distances of the anterior medial collateral ligament (AMCL) and lateral ulnar collateral ligament (LUCL), were compared between the surgical and intact sides.
This study included 42 patients, of which 12 with HEF demonstrated a similar flexion-extension angle and range of motion (ROM) and MEPS as the other patients. In patients with HEF, the surgical elbows showed limitations in flexion-extension (maximal flexion, 120.5° ± 5.3° vs 140.4° ± 6.8°; maximal extension, 13.1° ± 6.0° vs 6.4° ± 3.0°; ROM, 107.4° ± 9.9° vs 134.0° ± 6.8°; all Ps < 0.01) compared with the contralateral sides. During elbow flexion, a gradual valgus-to-varus transition of the ulna, increase in the AMCL insertion distance, and steady change in the LUCL insertion distance were observed, with no significant differences between the bilateral sides.
Patients treated with OA and HEF demonstrated similar elbow flexion-extension motion and function to those treated with OA alone. Although the use of HEF could not restore an intact flexion-extension ROM and might result in some minor but not significant changes in kinematics, it contributed to clinical outcomes comparable to that of the treatment with OA alone.
切开松解术（OA）联合铰链式外固定架（HEF）是治疗肘部僵硬的一种有前途的手术选择。本研究旨在探讨 OA 联合 HEF 治疗肘部僵硬后肘部运动学和功能的变化。
2017 年 8 月至 2019 年 7 月，招募因肘部僵硬接受 OA 治疗或 OA 联合 HEF 治疗的患者。在 1 年的随访期间，记录和比较了有无 HEF 的患者的肘部屈伸运动和功能（Mayo 肘部功能评分，MEPS）。此外，术后 6 周对使用 HEF 的患者进行双透视检查。比较手术侧和健侧的前内侧副韧带（AMCL）和外侧尺侧副韧带（LUCL）的附着点的屈伸和内外翻运动，以及韧带附着点的距离。
本研究共纳入 42 例患者，其中 12 例使用 HEF 的患者的屈伸角度和活动范围（ROM）以及 MEPS 与其他患者相似。在使用 HEF 的患者中，手术侧的肘部在屈伸方面存在限制（最大屈曲 120.5°±5.3°vs 140.4°±6.8°；最大伸展 13.1°±6.0°vs 6.4°±3.0°；ROM 107.4°±9.9°vs 134.0°±6.8°；所有 P 值均<0.01），与对侧相比。在肘部屈曲过程中，尺骨逐渐由内翻转为外翻，AMCL 附着点距离增加，LUCL 附着点距离稳定变化，但双侧之间无显著差异。
OA 联合 HEF 治疗的患者与单纯 OA 治疗的患者相比，肘部屈伸运动和功能相似。尽管使用 HEF 并不能恢复完整的屈伸 ROM，并且可能导致一些轻微但无统计学意义的运动学变化，但它有助于获得与单纯 OA 治疗相当的临床结果。
