肱尺关节成形术治疗肘关节僵直的临床疗效分析

摘要

目的：观察肱尺关节成形术治疗肘关节僵直的临床疗效。方法回顾性分析2013年1月至2015年6月在我科采用肱尺关节成形术治疗肘关节僵直患者12例，其中男10例，女2例，年龄为41~62岁，平均为（52.9±6.5）岁；所有患者均存在不同程度肘关节活动受限，影像学检查均可见肘关节骨性关节炎表现，其中5例患者可见关节囊内游离体生成。所有患者均通过肘后入路在鹰嘴窝开窗，清理、松解肘关节的前后侧并解除鹰嘴及冠状突的骨赘阻挡，达到清除阻挡、减轻疼痛、增加活动度的目的。采用梅奥肘关节功能表评估患者手术前后肘关节活动度及疼痛程度。结果12例患者获得6~20个月术后随访，平均（11.8±1.0）个月。患者术前疼痛评分为3~6分，平均（5.08±1.08）分，肘关节屈伸活动范围＜90°，平均42.08°±17.64°。术后疼痛评分为1~4分，平均（2.5±1.0）分，大多数患者肘关节屈伸活动范围＞90°，平均116.25°±16.80°。手术前后疼痛评分、活动度比较，差异均有统计学意义（均P＜0.05）。结论采用肱尺关节成形术治疗肘关节僵直，对患者术后疼痛缓解及活动度改善有明显作用，尤其适用于严重肘关节僵直患者，对肘关节活动度改善效果明显。%Objective To observe the clinical curative effect of ulnohumeral arthroplasty for elbow joint stiffness. Methods A retrospective analysis was performed from January 2013 to June 2015 in our depart⁃ment using ulnohumeral arthroplasty in 12 cases of elbow stiffness, including 10 males and 2 females with age ranging from 41⁃62 years old (mean 52.9 ± 6.47). All patients had different degrees of elbow motion limited. Imaging examination showed that the elbow joint osteoarthritis, and the formation of free body of joint capsule was found in 5 patients. A window in the fossae olecranon was opened via the posterior approach of elbow in all patients, the front and back sides of the elbow joint were cleared and loosened, the osteophyma barrier from theolecranon and coronoid process was relieved, and the goals of removing obstruction, reducing pain and increasing the degree of activity were achieved. Regular follow⁃up was done after operation. The Mayo elbow function scale was used to assess the elbow function before and after operation. Results Twelve patients were postoperatively followed up for 6⁃20 months (average 11.8 months). The preoperative pain scores were 3⁃6 points (mean 5.08±1.08), and the range of motion of the elbow joint was less than 90° (average 42.08°±17.64°). The postoperative pain scores were 1⁃4 points (mean 2.5±1.0), and the range of motion of the elbow joint in the majority of patients was more than 90° (116.25°±16.8°). There was significant difference in the range of motion of the elbow joint and pain score before and after operation (P<0.05). Conclusion Ulnohumeral arthroplasty can relieve the postoperative pain and increase the range of the motion of the elbow joint obviously in the patient with elbow stiffness, especially in patients with severe elbow stiffness, the elbow motion was effectively improved.