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创伤后肘僵硬伴异位骨化的治疗与康复。

Treatment and rehabilitation of post-traumatic elbow stiffness with heterotopic ossification.

机构信息

Jinzhou Medical University, Jinzhou, Liaoning, 121011, China; Rehabilitation Center, Beijing Rehabilitation Hospital Affiliated to Capital Medical University, Beijing,100144, China.

Institute of Orthopedics, Chinese PLA General Hospital, BeijInstitute of Orthopedics, Chinese PLA General Hospital, Beijing Key Laboratory of Regenerative Medicine in Orthopedics, Key Laboratory of Musculoskeletal Trauma & War Injuries PLA, Beijing, 100853, Chinaing Key Laboratory of Regenerative Medicine in Orthopedics, Key Laboratory of Musculoskeletal Trauma & War Injuries PLA, Beijing, 100853, China.

出版信息

J Plast Surg Hand Surg. 2024 Feb 4;59:18-23. doi: 10.2340/jphs.v59.18363.

Abstract

AIM

To investigate surgical treatment, postoperative rehabilitation and prevention of heterotopic ossification (HO) in patients with post-traumatic elbow stiffness.

METHODS

We performed a retrospective review of patients with post-traumatic elbow stiffness combined with HO between 2007 and 2021. This study was performed on a total of 15 patients (18 elbows) admitted to our hospital, consisting of 12 males and 3 females, with post-traumatic stiffness of the elbow combined with HO, where elbow function could not be recovered by rehabilitation and orthosis treatment. Fifteen patients were treated by surgical excision of heterotopic bones and release of elbow contracture combined with postoperative rehabilitation and orthosis-wearing. Comprehensive treatments, including radiation, oral ibuprofen medication, and manipulation techniques to improve range of motion, were used to prevent HO recurrence. The flexion-extension arc and functional score of the elbow were measured after treatment and compared with the preoperative measurements. Roentgenography was used to observe HO recurrence.

RESULTS

After surgical treatment and postoperative rehabilitation, the patients' range of motion improved, and the functional score improved considerably. The postoperative flexion-extension arc and The Hospital for Special Surgery (HSS) functional score were statistically significantly higher than the preoperative values (p < 0.01). Roentgenographic examination showed no HO recurrence during the follow-up period.

CONCLUSION

Surgical excision of heterotopic bones and elbow contracture release combined with postoperative rehabilitation and preventative HO measures can be an effective treatment for cases of post-traumatic elbow stiffness combined with HO, for which conservative treatment is ineffective.

摘要

目的

探讨创伤后肘僵硬伴异位骨化(HO)患者的手术治疗、术后康复及预防异位骨化的方法。

方法

回顾性分析 2007 年至 2021 年间收治的创伤后肘僵硬伴 HO 患者。共 15 例(18 肘)患者符合纳入标准,其中男 12 例,女 3 例,均为创伤后肘僵硬合并 HO,经康复和支具治疗后无法恢复肘关节功能。15 例患者均行手术切除异位骨和松解肘挛缩,术后辅以康复和支具治疗。综合应用放射治疗、口服布洛芬药物、手法松动等措施来预防 HO 复发。治疗后测量肘关节屈伸弧和功能评分,并与术前测量值进行比较。X 线片观察 HO 复发情况。

结果

手术治疗和术后康复后,患者的活动度改善,功能评分显著提高。术后屈伸弧和美国特种外科医院(HSS)功能评分均明显高于术前(p < 0.01)。随访期间 X 线片未见 HO 复发。

结论

对于保守治疗无效的创伤后肘僵硬伴 HO 患者,手术切除异位骨和松解肘挛缩,结合术后康复和预防 HO 措施是一种有效的治疗方法。

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