Gómez-Vieira Luis Alfredo, Azevedo-Gómez Gisele Florence C, Assunção Jorge, Gracitelli Mauro E, Andrade-Silva Fernando B, Ferreira Neto Arnaldo A, Malavolta Eduardo A
Orthopedics, Hospital Mater Dei, Salvador, BRA.
Radiology, Hospital Português da Bahia, Salvador, BRA.
Cureus. 2025 Apr 4;17(4):e81723. doi: 10.7759/cureus.81723. eCollection 2025 Apr.
Introduction Elbow stiffness can be disabling when performing activities. Surgery is indicated when conservative treatment fails. In older patients, the most appropriate surgical option is total elbow arthroplasty. However, in younger patients, the choice of surgery remains a topic of discussion. Materials and methods This study was a retrospective case series with a five-year follow-up, evaluating the outcomes of interpositional arthroplasty with dermal grafting and a hinged external fixator for elbow osteoarthrosis associated with stiffness in young adults according to the Mayo Elbow Performance Score (MEPS), the quickDASH score, the Visual Analogue Scale (VAS), and range of motion (ROM). Outcomes were assessed preoperatively and at 3, 6, 12, 24, and 60 months postoperatively. Imaging evaluations were performed preoperatively and at the 60-month follow-up. All complications were documented. Results We evaluated 40 patients. The MEPS increased from 42.6 ± 12.2 to 70.3 ± 18.6 (p < 0.001). The quickDASH score decreased from 43.4 ± 3.2 to 25.3 ± 9.7 (p < 0.001), and the VAS score decreased from 8.7 ± 2.0 to 3.7 ± 2.7 at the end of follow-up (p < 0.001). The flexion-extension arc increased from 49˚ ± 27˚ to 92˚ ± 29˚ (p < 0.001). Imaging studies showed a reduction in joint narrowing, a decrease in osteophytes, a higher radiographic classification of arthrosis, and fewer loose bodies. A total of 65% of patients experienced transient complications, while 5% had complications requiring reoperation, including arthrodesis and total elbow arthroplasty. Conclusions Interpositional arthroplasty with dermal grafting and a hinged external fixator for elbow osteoarthrosis associated with stiffness in young adults significantly improves clinical functional scale scores, ROM, and radiological appearance at the five-year follow-up. Despite the high rate of complications, most were transient and manageable, with only a small percentage of cases (5%) requiring surgical reintervention. The procedure demonstrated sustained functional benefits over time, with early improvements in pain and mobility stabilizing in the long term.
引言 肘关节僵硬在进行日常活动时会导致功能障碍。保守治疗失败后则需进行手术治疗。对于老年患者，最合适的手术选择是全肘关节置换术。然而，对于年轻患者，手术方式的选择仍是一个讨论的话题。
材料与方法 本研究为一项回顾性病例系列研究，随访期为五年，根据梅奥肘关节功能评分（MEPS）、快速DASH评分、视觉模拟量表（VAS）和活动范围（ROM）评估采用真皮移植和铰链式外固定器的间置关节成形术治疗年轻成人肘关节骨关节炎伴僵硬的疗效。在术前以及术后3、6、12、24和60个月对疗效进行评估。在术前和60个月随访时进行影像学评估。记录所有并发症。
结果 我们评估了40例患者。MEPS评分从42.6±12.2提高到70.3±18.6（p<0.001）。快速DASH评分从43.4±3.2降至25.3±9.7（p<0.001），随访结束时VAS评分从8.7±2.转到3.7±2.7（p<0.001）。屈伸弧从49˚±27˚增加到92˚±29˚（p<0.001）。影像学研究显示关节间隙变窄减轻、骨赘减少、关节病的放射学分级提高以及游离体减少。共有65%的患者出现短暂并发症，而5%的患者出现需要再次手术的并发症，包括关节融合术和全肘关节置换术。
结论 采用真皮移植和铰链式外固定器的间置关节成形术治疗年轻成人肘关节骨关节炎伴僵硬，在五年随访时可显著改善临床功能量表评分、ROM和放射学表现。尽管并发症发生率较高，但大多数为短暂性且可控制，只有一小部分病例（5%）需要再次手术干预。随着时间推移，该手术显示出持续的功能益处，疼痛和活动能力早期改善在长期内得以稳定。
