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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/OL]. 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/OL]. 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)
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