切换至 "中华医学电子期刊资源库"

中华肩肘外科电子杂志 ›› 2020, Vol. 08 ›› Issue (03) : 232 -236. doi: 10.3877/cma.j.issn.2095-5790.2020.03.008

所属专题: 文献

论著

肘关节粘连松解术中减少射频消融的使用对术后疗效的影响
杨春喜1,(), 杜琳1, 刘晓琳1, 张炜1, 赵耀超1, 王友1   
  1. 1. 200001 上海交通大学医学院附属仁济医院骨关节外科
  • 收稿日期:2020-04-15 出版日期:2020-08-05
  • 通信作者: 杨春喜
  • 基金资助:
    上海市科委引导类课题面上项目(16411971700)

The effect of reduced radiofrequency ablation on postoperative drainage of elbow joint arthrolysis

Chunxi Yang1,(), Lin Du1, Xiaolin Liu1, Wei Zhang1, Yaochao Zhao1, You Wang1   

  1. 1. Department of Bone and Joint Surgery, Renji Hospital Affiliated to Shanghai Jiaotong University School of Medicine, Shanghai 200001, China
  • Received:2020-04-15 Published:2020-08-05
  • Corresponding author: Chunxi Yang
引用本文:

杨春喜, 杜琳, 刘晓琳, 张炜, 赵耀超, 王友. 肘关节粘连松解术中减少射频消融的使用对术后疗效的影响[J]. 中华肩肘外科电子杂志, 2020, 08(03): 232-236.

Chunxi Yang, Lin Du, Xiaolin Liu, Wei Zhang, Yaochao Zhao, You Wang. The effect of reduced radiofrequency ablation on postoperative drainage of elbow joint arthrolysis[J]. Chinese Journal of Shoulder and Elbow(Electronic Edition), 2020, 08(03): 232-236.

目的

对比在肘关节镜下粘连松解术使用射频消融或刨刀进行关节囊松解、炎性滑膜切除对术后关节引流量的影响。

方法

将上海交通大学医学院附属仁济医院收治的骨关节炎性肘关节粘连患者24例随机分为2组,每组12例。射频消融组:使用射频消融进行滑膜切除和关节松解;刨刀组:使用刨刀进行滑膜切除和关节松解。对比术后关节引流量、关节屈伸活动度、关节功能评分等。

结果

刨刀组术后引流量为(32.9±12.3)ml显著少于射频消融组(110.0±31.4)ml(P=0.00)。术后引流管留置时间射频消融组为(3.1±1.3)d,显著多于刨刀组的(1.3±0.5)d(P=0.00),但两组间关节活动度、功能评分恢复情况差异无统计学意义。

结论

进行肘关节镜下粘连松解术时,射频消融的过多使用会增加术后引流量,使用刨刀进行滑膜切除和松解优于射频消融。

Background

The incidence of elbow osteoarthritis in the adult is nearly 2%, and it can cause elbow joint adhesion, which is manifested by pain in elbow joints, accompanied by various degrees of flexion, extension, and rotation disorders. Elbow joint arthrolysis has attracted much attention in recent years, and the effect of the operation is affirmative. Due to the narrow joint cavity of the elbow joint, extensive joint capsule release and synovial clearance are needed in this operation. There is often more joint exudation after operation, even the incision is delayed to heal. Radiofrequency ablation has been widely used in arthroscopic surgery for joint capsule release, synovial cleaning, hemostasis, etc. However, radiofrequency ablation can cut through the local instantaneous high temperature of the knife head, which will increase the temperature of surrounding tissues and liquid, and even cause extensive thermal damage. Elbow joint space is narrow, which may lead to thermal injury more easily. In addition, radiofrequency ablation or planer knife is needed for extensive synovial clearance, joint capsule release and resection, and ligament insertion release. Therefore, the influence of radiofrequency ablation and planer on the amount of joint exudation after arthrolysis of elbow joint needs to be confirmed.

Objective

To compare the effect of radiofrequency ablation or planer blade on the postoperative joint drainage in arthroscopic elbow arthrolysis.

Methods

A total of 24 patients with osteoarthritic elbow adhesions were randomly divided into 2 groups with 12 patients in each group. In the experimental group, radiofrequency ablation was used for synovial resection and joint release. In the control group, synovial resection and joint release were performed with a plane knife. The postoperative joint drainage, joint flexion and extension range and joint function score were compared.

Results

The postoperative drainage volume was (32.9±12.3) ml in the control group, which was significantly lower than that in the experimental group, which was (110.0± 31.4) ml (P=0.00) . The postoperative drainage tube indwining time in the experimental group was (3.1±1.3) days, which was significantly higher than that in the control group, which was (1.3±0.5) days (P=0.00) . However, there was no statistical difference in the functional score and recovery of joint range of motion between the two groups.

Conclusion

The excessive use of radiofrequency ablation can increase the postoperative drainage, and the use of planer blade for synovectomy and capsular release is better than radiofrequency ablation.

表1 两组患者术前、术后MEPI评分对比(分,±s)
图1 随机对照产生流程图
表2 两组患者术前、术后屈伸活动度对比(°,±s)
表3 两组患者术后引流量和引流管留置时间对比(±s)
[1]
Kwak JM, Kholinne E, Sun Y, et al. Intraobserver and interobserver reliability of the computed tomography-based radiographic classification of primary elbow osteoarthritis: comparison with plain radiograph-based classification and clinical assessment[J]. Osteoarthritis Cartilage,2019, 27(7):1057-1063.
[2]
Kim DM, Han M, Jeon IH, et al. Range-of-motion improvement and complication rate in open and arthroscopic osteocapsular arthroplasty for primary osteoarthritis of the elbow: a systematic review[J]. Int Orthop,2020, 44(2):329-339.
[3]
Kroonen LT, Piper SL, Ghatan AC. Arthroscopic management of elbow osteoarthritis[J]. J Hand Surg Am,2017, 42(8):640-650.
[4]
Kwak JM, Kholinne E, Sun Y, et al. Clinical outcome of osteocapsular arthroplasty for primary osteoarthritis of the elbow: comparison of arthroscopic and open procedure[J]. Arthroscopy,2019, 35(4):1083-1089.
[5]
Kwak JM, Kim H, Sun Y, et al. Arthroscopic osteocapsular arthroplasty for advanced-stage primary osteoarthritis of the elbow using a computed tomography-based classification[J]. J Shoulder Elbow Surg,2020, 29(5):989-995.
[6]
Akca F, Hubay M, Zima E, et al. High-volume lesions using a new second-generation open irrigation radiofrequency catheter are associated with the development of inhomogeneous lesions[J]. Pacing Clin Electrophysiol,2014, 37(7):864-873.
[7]
Noticewala MS, Levi MA, Ahmad CS, et al. Arthroscopic elbow osteocapsular arthroplasty[J]. Arthrosc Tech,2017, 6(6):e2111-e2118.
[8]
Noticewala MS, Trofa DP, Vance DD, et al. Elbow arthroscopy: 30-day postoperative complication profile and associated risk factors[J]. Arthroscopy,2018, 34(2):414-420.
[9]
Smith J, Field LD. Elbow arthroscopy made simple: indications and techniques[J]. Arthroscopy,2019, 35(7):1952-1953.
[10]
Huber M, Eder C, Mueller M, et al. Temperature profile of radiofrequency probe application in wrist arthroscopy: monopolar versus bipolar[J]. Arthroscopy,2013, 29(4):645-652.
[11]
Huynh V, Barbier O, Bajard X, et al. Subacromial temperature profile during bipolar radiofrequency use in shoulder arthroscopy. Comparison of Coblation((R)) vs. VAPR((R)) [J]. Orthop Traumatol Surg Res,2017, 103(4):489-491.
[12]
McCormick F, Alpaugh K, Nwachukwu BU, et al. Effect of radiofrequency use on hip arthroscopy irrigation fluid temperature [J]. Arthroscopy,2013, 29(2):336-342.
[13]
Haasters F, Helfen T, Bocker W, et al. The value of elbow arthroscopy in diagnosing and treatment of radial head fractures[J]. BMC Musculoskelet Disord,2019, 20(1):343.
[14]
Chivot M, Airaudi S, Galland A, et al. Analysis of parameters influencing intraarticular temperature during radiofrequency use in shoulder arthroscopy[J]. Eur J Orthop Surg Traumatol,2019, 29(6):1205-1210.
[15]
Zhang S, Xu B, Huang Q, et al. Early removal of drainage tube after fast-track primary total knee arthroplasty[J]. J Knee Surg,2017, 30(6):571-576.
[1] 陆婷, 范晴敏, 王洁, 万晓静, 许春芳, 董凤林. 超声引导下经皮穿刺置管引流对重症急性胰腺炎的疗效及应用时机的选择[J]. 中华医学超声杂志(电子版), 2024, 21(05): 511-516.
[2] 庄若语, 杭明辉, 李文华, 张霆, 侯炜. 膝骨关节炎半定量磁共振评分研究进展[J]. 中华关节外科杂志(电子版), 2024, 18(04): 545-552.
[3] 李志文, 李远志, 李华, 方志远. 糖皮质激素治疗膝骨关节炎疗效的网状Meta分析[J]. 中华关节外科杂志(电子版), 2024, 18(04): 484-496.
[4] 李程, 朱梁, 庞勇, 查国春, 仇尚, 孙伟, 冯硕. 侧侧缝合联合无结缝线桥技术治疗大型L型肩袖撕裂[J]. 中华关节外科杂志(电子版), 2024, 18(03): 301-306.
[5] 王冰, 孙海宁, 于秀淳, 周珂, 翟凯, 苗族康. 膝骨关节炎的活动衬垫型单髁置换疗效与假体生存率[J]. 中华关节外科杂志(电子版), 2024, 18(03): 337-345.
[6] 张江礼, 刘金辉, 潘西庆, 刘光源, 范虓. 全膝关节置换应用智能辅助手术导航系统治疗膝骨关节炎[J]. 中华关节外科杂志(电子版), 2024, 18(03): 346-351.
[7] 张刚, 秦勇, 黄超, 薛震, 吕松岑. 基于骨关节炎软骨细胞表型转化的新兴治疗靶点[J]. 中华关节外科杂志(电子版), 2024, 18(03): 352-362.
[8] 王典, 刘双赫, 曾峥. 肩关节镜术后肌肉功能改变对颈椎形态及矢状面参数影响的自身前后对照队列研究[J]. 中华损伤与修复杂志(电子版), 2024, 19(05): 371-378.
[9] 党军强, 杨雁灵, 汪庆强, 尚琳, 朱磊, 项红军. 主动经皮穿刺引流治疗重症急性胰腺炎并发急性坏死物积聚的疗效分析[J]. 中华普外科手术学杂志(电子版), 2024, 18(06): 671-674.
[10] 刘军, 周代琴, 徐雪梅, 于仕杰. ERCP+EST+ENBD取石术对胆总管结石的疗效及安全性研究[J]. 中华普外科手术学杂志(电子版), 2024, 18(03): 299-302.
[11] 邓杨, 彭豪, 刘剑文. 腹腔镜疝修补术腹膜前负压引流的效果和长期安全性研究[J]. 中华疝和腹壁外科杂志(电子版), 2024, 18(04): 402-405.
[12] 滕达, 许悦, 张萌. 腹腔镜下经胆囊管胆总管探查取石术治疗胆总管结石的临床疗效[J]. 中华肝脏外科手术学电子杂志, 2024, 13(04): 537-542.
[13] 冯嘉楠, 蔡磊, 何国林, 付顺军, 张成, 冯周彬, 温耀鸿, 谭洪坤, 潘明新. 腹腔镜胆总管切开探查取石一期缝合的安全性与疗效:附128例分析[J]. 中华肝脏外科手术学电子杂志, 2024, 13(04): 543-550.
[14] 肖丹, 陈辰, 查晔军, 公茂琪, 花克涵, 孙伟桐, 蒋协远. 改良松解术治疗创伤后肘关节僵硬的疗效及危险因素分析[J]. 中华老年骨科与康复电子杂志, 2024, 10(05): 257-263.
[15] 高广涵, 张耀南, 石磊, 王林, 王飞, 郑子天, 王鸿禹, 郭民政, 薛庆云. 膝骨关节炎患者前交叉韧带功能影像学影响因素分析[J]. 中华老年骨科与康复电子杂志, 2024, 10(05): 301-307.
阅读次数
全文


摘要