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中华肩肘外科电子杂志

中华肩肘外科电子杂志 ›› 2021, Vol. 09 ›› Issue (03) : 257 -262. doi: 10.3877/cma.j.issn.2095-5790.2021.03.011

论著

张力性支具结合开放松解术治疗肘关节僵硬的初步疗效分析
熊晨1, 张堃2, 何晓2, 杨佳瑞2, 何昌军2, 黄伟2, 朱养均2, 衡立松2,†()   
  1. 1. 716000　延安大学医学院（外科学专业）
    2. 710054　西安交通大学医学院附属红会医院创伤骨科
  • 收稿日期:2020-11-18 出版日期:2021-09-13
  • 通信作者: 衡立松
  • 基金资助:
    陕西省重点研发计划项目(2017SF-197); 西安市科技计划项目(20YXYJ004)

Preliminary efficacy analysis of tension brace combined with open arthrolysis in the treatment of elbow ankylosis

Chen Xiong1, Kun Zhang2, Xiao He2, Jiarui Yang2, Changjun He2, Wei Huang2, Yangjun Zhu2, Lisong Heng2,†()   

  1. 1. Yan'an University, Yan'an 716000, China
    2. Department of Orthopaedic and Trauma, Honghui Hospital, Xi'an Jiaotong University, Xi'an 710054, China
  • Received:2020-11-18 Published:2021-09-13
  • Corresponding author: Lisong Heng
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引用本文：

熊晨, 张堃, 何晓, 杨佳瑞, 何昌军, 黄伟, 朱养均, 衡立松. 张力性支具结合开放松解术治疗肘关节僵硬的初步疗效分析[J]. 中华肩肘外科电子杂志, 2021, 09(03): 257-262.

Chen Xiong, Kun Zhang, Xiao He, Jiarui Yang, Changjun He, Wei Huang, Yangjun Zhu, Lisong Heng. Preliminary efficacy analysis of tension brace combined with open arthrolysis in the treatment of elbow ankylosis[J]. Chinese Journal of Shoulder and Elbow(Electronic Edition), 2021, 09(03): 257-262.

目的

探讨张力性支具结合开放性肘关节松解术治疗肘关节僵硬的初步疗效。

方法

回顾性分析我院采用开放性肘关节松解术治疗的40例肘关节僵硬患者资料。单纯采用开放性肘关节松解术为对照组（21例），采用张力性支具结合开放肘关节松解术为观察组（19例）。比较两组患者末次随访时肘关节屈伸、旋转活动度和Mayo肘关节功能评分，并评定疗效。

结果

所有患者术后均获得随访，随访时间12~28个月，平均18.9个月。对照组与观察组相比，术后末次随访时肘关节旋转活动度[（142.14±34.91）° VS （136.32±42.75）°, t=0.562, P=0.910]差异无统计学意义；肘关节屈伸活动度[（95.71±10.87 ）° VS （107.47±14.13）°, t=2.966, P=0.005]和Mayo肘关节功能评分[（72.62±6.05）分VS （80.79±9.61）分, t=1.456, P=0.029]观察组显著高于对照组，差异均有统计学意义。

结论

张力性支具结合开放性肘关节松解术可以改善肘关节的屈伸活动度和肘关节功能，疗效满意。

关键词: 肘关节, 僵硬, 松解术, 治疗结果
Background

When a fracture occurs around the elbow, it can easily lead to joint stiffness if it is not properly treated and rehabilitated. The incidence of post-traumatic elbow ankylosis is 3% to 20%, which seriously affects people’s daily life. After the single release, if the elbow joint rehabilitation exercise is not appropriate, the joint stiffness may reoccur. In order to avoid the recurrence of stiffness, orthopaedic surgeons take a variety of measures to carry out rehabilitation exercise and improve the elbow function.

Objective

To investigate the preliminary efficacy of tension brace combined with open elbow arthrolysis in the treatment of elbow ankylosis.

Methods

The data of 40 patients with elbow ankylosis treated with open elbow lysis in our hospital were analyzed retrospectively. Open elbow joint arthrolysis was used in control group (n=21) and tension brace combined with open elbow joint release in observation group (n=19) . The ranges of elbow flexion, extension and rotation and Mayo elbow function score were compared between the two groups during the last follow-up, and the curative effect was evaluated.

Results

All patients were followed up for 12 to 28 months with an average of 18.9 months. There was no statistical difference in the range of elbow joint rotation between the control group and the observation group in the last follow-up[ (142.14 ±34.91) °vs (136.32±42.75) °, t=0.562, P=0.910], but there was significant difference in the ranges of flexion and extension [ (95.71±10.87) ° vs (107.47±14.13) °, t=2.966, P=0.005] and Mayo elbow function score [ (72.62±6.05) score vs (80.79±9.61) score, t=1.456, P=0.029]. The ranges of elbow flexion and extension and Mayo elbow function score of the observation group were significantly higher than those of the control group in the last follow-up.

Conclusion

Tension brace combined with open elbow joint arthrolysis can improve the ranges of elbow flexion and extension of elbow joint and improve the function of the elbow joint.

Key words: Elbow, Stiffness, Arthrolysis, Treatment Outcome
图1 肘关节张力性支具
表1 对照组与观察组患者术前一般资料比较
组别 例数 性别 侧别 年龄（岁，±s） 肘关节僵硬时长（月，±s） 屈伸活动度（°，±s） 旋转活动度（°，±s） Mayo肘关节功能评分（分，±s）
（男/女） （左/右）
对照组 21 13/8 9/12 38.19±12.25 15.14±9.48 32.14±29.60 114.05±47.2 53.57±7.93
观察组 19 10/9 9/10 41.26±11.05 10.63±5.01 23.95±16.63 110.26±57.46 49.21±8.54
F值   0.351 0.082 0.830 1.211 1.092 0.530 1.124
P值   0.554 0.775 0.421 0.106 0.283 0.941 0.160
表2 对照组与观察组患者术后屈伸、旋转活动度和Mayo肘关节功能评分比较（±s）
组别 例数 屈伸活动度（°） 旋转活动度（°） Mayo肘关节功能评分（分）
对照组 21 95.71±10.87 142.14±34.91 72.62±6.05
观察组 19 107.47±14.13 136.32±42.75 80.79±9.61
F值   2.966 0.562 1.456
P值   0.005 0.910 0.029
图2 患者，男性，38岁，诊断为肱骨髁间骨折术后肘关节僵硬，术前患者肘关节存在屈曲受限，屈曲约70°（A）；术前X线片显示肱尺关节异位骨化（B、C）；开放性松解术后给予佩戴张力性支具（D）；术后9个月复查，肘关节屈伸明显较前好转（伸直0°，屈曲130°）（E、F）；复查X线示肱尺关节异位骨化减少，内固定位置良好（缝合锚钉对外侧尺副韧带进行缝合固定）（G、H）
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