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中华肩肘外科电子杂志 ›› 2019, Vol. 07 ›› Issue (04) : 355 -359. doi: 10.3877/cma.j.issn.2095-5790.2019.04.011

所属专题: 文献

论著

关节镜下治疗肘关节骨性关节炎伴僵硬短期疗效观察
张忠1, 齐岩松2, 吴海贺2, 包呼日查2, 徐永胜2,()   
  1. 1. 016000 乌海市人民医院骨科
    2. 010017 呼和浩特,内蒙古自治区人民医院骨关节科(运动医学中心)
  • 收稿日期:2018-03-16 出版日期:2019-11-05
  • 通信作者: 徐永胜
  • 基金资助:
    国家自然科学基金地区科学基金项目(81560374); 内蒙古自治区科技计划项目(201602098); 内蒙古自治区人民医院院内基金项目(201501、201810)

Short-term efficacy observation of arthroscopy in the treatment of elbow joint osteoarthritis with stiffness

Zhong Zhang1, Yansong Qi2, Haihe Wu2, Huricha Bao2, Yongsheng Xu2,()   

  1. 1. Department of Orthopaedics, Wuhai People’s Hospital, Wuhai 016000, China
    2. Department of Arthrology (Sports Medicine Center) , Inner Mongolia People’s Hospital , Hohhot 010017, China
  • Received:2018-03-16 Published:2019-11-05
  • Corresponding author: Yongsheng Xu
  • About author:
    Corresponding author: Xu Yongsheng, Email:
引用本文:

张忠, 齐岩松, 吴海贺, 包呼日查, 徐永胜. 关节镜下治疗肘关节骨性关节炎伴僵硬短期疗效观察[J]. 中华肩肘外科电子杂志, 2019, 07(04): 355-359.

Zhong Zhang, Yansong Qi, Haihe Wu, Huricha Bao, Yongsheng Xu. Short-term efficacy observation of arthroscopy in the treatment of elbow joint osteoarthritis with stiffness[J]. Chinese Journal of Shoulder and Elbow(Electronic Edition), 2019, 07(04): 355-359.

目的

探讨肘关节镜下治疗肘关节骨性关节炎伴关节僵硬的临床疗效。

方法

回顾性分析2015年5月至2018年6月期间于乌海市人民医院收治肘关节骨性关节炎伴肘关节僵硬的患者17例,所有患者均肘关节镜下行滑膜骨赘清理、关节囊松解、游离体取出、关节结构成型,术后均行专业康复功能训练,观察比较围手术期前、后肘关节视觉模拟评分(visual analogue scale,VAS)、关节活动度、肘关节功能Mayo评分和美国特种外科医院膝关节评分(hospital for special surgery knee score,HSS)的差异,评价其临床疗效。

结果

术后均无神经血管损伤、肘关节副韧带损伤、切口愈合不良、感染、异位骨化等术后并发症的发生。所有患者在术后12个月随访时进行评估,VAS评分术前(6.17±1.07)分,术后(2.94±0.65)分;肘关节Mayo评分术前(44.41±3.42)分,术后(93.23±1.71)分;HSS评分术前(45.29±6.69)分,术后(88.41±2.59)分,差异均有统计学意义;术后关节屈伸及旋转活动度显著改善。

结论

应用关节镜技术治疗肘关节骨性关节炎伴肘关节僵硬能够显著改善肘关节功能,具有创伤小、恢复快、疗效可靠等优点。

Background

The elbow joint is one of the flexible and complex joints of the human body. It has the function of extension and flexion, and its damage will seriously affect the function of hand and forearm, and greatly reduce the quality of life. There are auxiliary ligaments around the elbow joint, and the joint is tightly matched. The elbow joint injury will induce inflammatory reactions (e.g. osteoarthritis) , resulting in the adhesion joint capsule and surrounding tissue and thus increasing the incidence of stiffness and rigidity. Previous studies have shown that the incidence of post-traumatic elbow stiffness is about 16% to 40%, and its incidence increases with the severity of fractures. Due to the narrow space and complicated structures of the elbow joint cavity, there are many nerves and vessels around, which make the difficulty and risk of surgery increase. Conventional elbow joint open release and debridement surgery are more traumatic and difficult for rehabilitation training, and the postoperative effects are uneven. Objective To investigate the clinical efficacy of elbow arthroscopy in the treatment of elbow osteoarthritis with joint stiffness.

Methods

From May 2015 to June 2018, a retrospective analysis of 17 patients with elbow joint osteoarthritis and stiffness in our hospital was performed. All patients received synovial osteophyte cleaning, capsule release, free body removal and joint structure arthroplasty, and the professional rehabilitation was performed after operation. The VAS score, range of motion, Mayo score and HSS score were observed and compared in the perioperative period for the assessment of clinical efficacy.

Results

There were no postoperative complications such as neurovascular injury, elbow collateral ligament injury, poor postoperative incision healing, infection and heterotopic ossifications. All patients were followed up for 12 months after operation. The preoperative VAS score was (6.17±1.07) points and the postoperative VAS score was (2.94±0.65) points. The preoperative Mayo score was (44.41±3.42) points and the postoperative Mayo score was (93.23±1.71) points. The preoperative HSS score was (45.29±6.69) points and the postoperative HSS score was (88.41±2.59) points. There were significant differences in these scores. The postoperative range of flexion and extension as well as rotation was significantly improved.

Conclusion

Arthroscopic technique for treatment of elbow osteoarthritis with elbow joint stiffness can significantly improve elbow joint function with the advantages of minimal trauma, quick recovery and reliable efficacy.

图1 肘前方游离体、骨赘
图2 增生肥大的冠突(左侧)
图3 磨除冠突窝内增生的骨赘
图4 磨除冠突的增生骨赘,已部分磨除
图5 磨除鹰嘴及鹰嘴窝内骨赘(上方是鹰嘴窝,下方是鹰嘴尖)
图6 磨除桡骨头周围骨赘
图7 术后肘关节完全伸直
表1 患者术前、术后12个月肘关节功能评分比较(±s)
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