手术治疗合并疼痛的创伤后肘关节功能障碍

摘要

目的 探讨采用手术治疗合并疼痛的创伤后肘关节功能障碍的临床效果.方法 2011年1月～2014年12月贵阳市第四人民医院采用肘关节松解术治疗30例伴有疼痛的创伤后肘关节僵硬患者,男性20例,女性10例;年龄18～65岁,平均39.0岁.其中,23例轻中度疼痛患者行单纯肘关节松解术;4例重度疼痛患者伴有肘关节陈旧性脱位,术中在充分松解肘关节后复位肘关节;3例疼痛剧烈患者在行肘关节松解术同时作真皮移植间隔式肘关节成形术.24例使用了外固定支架辅助早期功能锻炼.结果 术后随访时间12～18个月,平均14个月.患者肘关节活动范围和疼痛症状均得到明显改善,其中2例极重度僵硬改善为中度僵硬,17例中度以上僵硬患者改善为轻度僵硬,其余11例轻度改善为无僵硬;改善率100%.6例中重度疼痛缓解为轻度疼痛,其余24例疼痛消失;疼痛缓解率100%.肘关节功能评定采用Mayo综合评分,术前评分:优0例,良6例,可12例,差12例;术后评分:优20例,良6例,可4例;优良率87%.术后和术前比较差异有统计学意义(P<0.05).伤口均一期愈合,针道口无感染、无肘关节不稳等并发症.结论 采用手术治疗肘关节僵硬能有效改善肘关节屈伸功能,同时对合并有陈旧性脱位或肘关节炎引起的疼痛也可获得较好疗效.%Objective To discuss the clinical efficacy of patients treated with surgical treatment for posttraumatic elbow stiffness combined with pain.Methods From Jan.2011 to Dec.2014,30 cases of posttraumatic constracture of the elbow combined with pain were performed by operation in our hospital.There were 20 males and 10 females,with an average age of 39.0 years(range,18-65years).Twenty-three cases of these patients with mild or moderate pain got a simple elbow release operation.There were 4 cases of severe pain complicated with elbow dislocation,and reduction was performed after release operation.Elbow release and arthroplasty were performed in 3 cases that had severe osteoarthritis and severe pain.A total of 24 patients were installed external fixator after operation for early functional exercise.Results All patients were followed up for an average time of 14 months (from 12 to 18 months).All patients were significantly improved in the range of elbow and pain symptoms.Two patients with severe stiffness improved to moderate stiffness,17 patients with moderate or severe stiffness improved to mild stiffness,and 11 cases had stiffness disappeared.The improvement rate was 100%.Six cases of moderate or severe pain relieved to mild pain,and the other 24 patients had pain disappeared.The pain relief rate was 100%.Mayo elbow performance score was employed before and after surgery.The results were good in 6 cases,fair in 12 cases and poor in 12 cases before surgery.After surgery,results were excellent in 20 cases,good in 6 cases and fair in 4 cases,and the excellent and good rate was 87%.The difference between preoperation and postoperation was statistically significant(P<0.05).All incisions healed without complications like infection or elbow instability.Conclusion Surgical treatment can effectively improve the elbow flexion and extension function,meanwhile,associated pain caused by old dislocation or arthritis of elbow can also get good effect.