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中华肩肘外科电子杂志 ›› 2023, Vol. 11 ›› Issue (02) : 181 -185. doi: 10.3877/cma.j.issn.2095-5790.2023.02.016

综述

创伤后肘关节僵硬的病理机制及治疗进展
赵佳音, 张晓萌, 张艳, 李立, 王瑞灯()   
  1. 100044 北京大学人民医院创伤骨科
    100191 北京大学第三医院创伤骨科
  • 收稿日期:2023-03-13 出版日期:2023-05-05
  • 通信作者: 王瑞灯

Pathological mechanism and treatment progress of post-traumatic stiff elbow

Jiayin Zhao, Xiaomeng Zhang, Yan Zhang   

  • Received:2023-03-13 Published:2023-05-05
引用本文:

赵佳音, 张晓萌, 张艳, 李立, 王瑞灯. 创伤后肘关节僵硬的病理机制及治疗进展[J/OL]. 中华肩肘外科电子杂志, 2023, 11(02): 181-185.

Jiayin Zhao, Xiaomeng Zhang, Yan Zhang. Pathological mechanism and treatment progress of post-traumatic stiff elbow[J/OL]. Chinese Journal of Shoulder and Elbow(Electronic Edition), 2023, 11(02): 181-185.

肘关节僵硬是肘关节外伤后的常见问题,可导致上肢功能受损。软组织挛缩和异位骨形成是运动受限的两个主要原因。最近的研究已经阐明了导致这些疾病的许多途径,但确切的机制仍然未知。功能障碍的严重程度取决于初始创伤的性质和所使用的治疗方法。根据病情的严重程度和潜在的违规结构,有几种不同的选择。手术治疗可能会显著改善运动,但很少能完全恢复,并发症并不少见。本文旨在阐述创伤后肘关节僵硬的病理机制及治疗进展。

表1 创伤后肘关节僵硬的手术方式及其特点
手术方式 适应证 优点/局限性 并发症
开放式关节松解术      
前路入路 肘部伸展丧失或前方异位骨化 在关节暴露不够,易损伤血管及神经 血管和神经损伤
内侧入路 存在尺神经损伤迹象的患者 可治疗尺神经的神经异常,但不能充分暴露肱骨-桡关节和外侧结构  
外侧入路 需要打开关节,松解前方和后方关节囊,并探查关节外侧部分 切口位于关节伸屈轴线上,伤口出现问题机会减少 尺神经损伤
后侧入路 需要内侧和外侧暴露时,或关节表面受到影响 对关节前侧暴露不够充分  
联合入路 需要大面积暴露时,视具体情况而定 充分暴露关节,但损伤大 血管和神经损伤,感染
关节镜下关节松解术 用于简单的肘关节挛缩:肘关节活动受限、运动弧度≥80°、无手术史或前次手术损伤小、无尺神经置、无内固定或内固定到位且对关节活动影响较小、无或仅有少量异位骨化且关节结构基本正常 切口小、失血量少、术后疼痛较轻、易康复 神经、血管、软骨组织等损伤
开放式手术加固定 单纯松解术效果不好,肘关节不稳定 能显著增加肘关节稳定性 感染
肘关节置换      
全肘关节置换术 没有其他治疗选择,对于活动较少的老年患者 较少应用 假体周围骨折、假体松动和机械老化、感染、肱三头肌破坏及神经麻痹
部分肘关节置换术 较少应用,一般用于肱桡关节软骨缺失而肱尺关节情况较好的患者;或肱骨小头关节面状况较差;或肱骨远端骨折不愈合或畸形愈合
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