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关节镜下松解辅助内侧小切口治疗非创伤性肘关节僵硬的疗效

[Effectiveness of arthroscopic release assisted with medial small incision in treatment of non-traumatic elbow stiffness].

作者信息

Lü Lijun, Chang Yanyan, Zhou Baojun, Gao Qiuming, Hu Jieliang, Chen Liyuan, Wei Kongxing, Gao Fujun, Li Wentao, Yuan Xin, Jin Yibin

机构信息

Department of Joint Surgery, First People's Hospital of Baiyin City, Baiyin Gansu, 730900, P. R. China.

Central Operating Room, First People's Hospital of Baiyin City, Baiyin Gansu, 730900, P. R. China.

出版信息

Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi. 2025 May 15;39(5):563-568. doi: 10.7507/1002-1892.202502076.

Abstract

OBJECTIVE

To explore the effectiveness of arthroscopic release of elbow joint assisted by medial small incision ulnar nerve release in the treatment of non-traumatic elbow stiffness.

METHODS

The clinical data of 15 patients with non-traumatic elbow stiffness treated with arthroscopic release of elbow joint assisted by medial small incision ulnar nerve release between April 2019 and September 2023 were retrospectively analyzed. There were 6 males and 9 females with an average age of 46 years ranging from 34 to 56 years. The causes included rheumatoid arthritis in 3 cases, gouty arthritis in 2 cases, loose bodies in 3 cases, and elbow osteoarthritis in 7 cases. There were 4 cases with ulnar neuritis and 3 cases with synovial osteochondromatosis. The duration of elbow stiffness ranged from 6 to 18 months, with an average of 10 months. The operation time and intraoperative blood loss were recorded. The effectiveness was evaluated by visual analogue scale (VAS) score, range of elbow motion (maximum flexion, maximum extension, and total flexion and extension), Mayo score, and Hospital for Special Surgery (HSS) elbow score.

RESULTS

The operation time was 60-90 minutes, with an average of 65 minutes, and the intraoperative blood loss was 40-100 mL, with an average of 62 mL. All patients were followed up 13-18 months, with an average of 14 months. There was no complication such as vascular and nerve injury, poor wound healing, collateral ligament injury, elbow joint space narrowing, osteophyte proliferation, or loose body formation around the joint. At last follow-up, the elbow range of motion (maximum flexion, maximum extension, and total flexion and extension), VAS score, and Mayo score significantly improved when compared with those before operation ( <0.05). The HSS elbow score was 85-95, with an average of 92; 12 cases were excellent, 3 cases were good, and the excellent and good rate was 100%.

CONCLUSION

Arthroscopic release of elbow joint assisted by medial small incision ulnar nerve release is an effective way to treat non-traumatic elbow stiffness, which has the advantages of small trauma, short operation time, and good effectiveness. It can carry out early elbow rehabilitation training and significantly improve elbow function.

摘要

目的

探讨关节镜下肘关节松解辅助内侧小切口尺神经松解治疗非创伤性肘关节僵硬的有效性。

方法

回顾性分析2019年4月至2023年9月期间采用关节镜下肘关节松解辅助内侧小切口尺神经松解治疗的15例非创伤性肘关节僵硬患者的临床资料。其中男性6例,女性9例,平均年龄46岁,年龄范围为34至56岁。病因包括类风湿关节炎3例、痛风性关节炎2例、游离体3例、肘关节骨关节炎7例。伴有尺神经炎4例,滑膜骨软骨瘤病3例。肘关节僵硬持续时间为6至18个月,平均10个月。记录手术时间和术中出血量。采用视觉模拟评分(VAS)、肘关节活动度(最大屈曲、最大伸展及总屈伸度)、Mayo评分及特殊外科医院(HSS)肘关节评分评估疗效。

结果

手术时间为60 - 90分钟,平均65分钟,术中出血量为40 - 100毫升,平均62毫升。所有患者均获随访13 - 18个月,平均14个月。未出现血管神经损伤、伤口愈合不良、侧副韧带损伤、肘关节间隙变窄、骨赘增生或关节周围游离体形成等并发症。末次随访时,与术前相比,肘关节活动度(最大屈曲、最大伸展及总屈伸度)、VAS评分及Mayo评分均显著改善(<0.05)。HSS肘关节评分为85 - 95分,平均92分;优12例,良3例,优良率为100%。

结论

关节镜下肘关节松解辅助内侧小切口尺神经松解是治疗非创伤性肘关节僵硬的有效方法,具有创伤小、手术时间短、疗效好等优点。可早期进行肘关节康复训练,显著改善肘关节功能。

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本文引用的文献

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Elbow Arthroscopy: Pearls to Avoid Nerve Injuries.肘关镜检查术:避免神经损伤的要点。
Arthroscopy. 2024 Aug;40(8):2160-2161. doi: 10.1016/j.arthro.2024.05.001.
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Outcomes of arthroscopic arthrolysis for the post-traumatic elbow stiffness.创伤后肘关节僵硬的关节镜下松解术的疗效
Knee Surg Sports Traumatol Arthrosc. 2015 Sep;23(9):2715-20. doi: 10.1007/s00167-014-3032-3. Epub 2014 May 15.
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Surgical treatment of post-traumatic elbow stiffness: a systematic review.创伤后肘关节僵硬的手术治疗:系统评价。
J Shoulder Elbow Surg. 2013 Apr;22(4):574-80. doi: 10.1016/j.jse.2012.11.010. Epub 2013 Feb 1.
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Complications of elbow arthroscopy.肘关节镜检查的并发症
J Bone Joint Surg Am. 2001 Jan;83(1):25-34. doi: 10.2106/00004623-200101000-00004.

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