论文部分内容阅读
目的 分析配合铰链式外固定支架的开放式肘关节松解术治疗肘关节功能障碍的疗效,探讨肘关节功能障碍的常见病因,为防治提供依据.方法 回顾性研究自2010年1月至2013年12月我院收治的245例肘关节功能障碍患者,对比松解术前后肘关节活动范围,分析病因特点及分布.结果 肘关节活动范围由(37±20)°增加至(121±12)°,肘关节MEPI评分由(57±10)分增加至(93±7)分,差异有统计学意义(P＜0.01).创伤性肘关节功能障碍占全部病因的90.61％,其病因构成前五位依次为肱骨远端骨折(34.29％)、肘关节骨折伴脱位(19.18％)、尺骨鹰嘴骨折(17.14％)、单纯肘关节脱位(10.61％)、桡骨头骨折(9.39％).其中161例患者(65.71％)伴有不同程度异位骨化组织.制动时间、早期康复治疗及合并颅脑损伤或烧伤为影响异位骨化形成的重要因素.女性肘关节脱位所致肘关节功能障碍的比例明显高于男性.非创伤性肘关节功能障碍病因占全部患者的9.39％,其病因以增生性滑膜炎为主.结论 配合铰链式外固定支架的开放式肘关节松解术可以增加肘关节功能障碍患者关节活动度,取得良好的疗效.肘关节创伤及其并发的异位骨化为创伤性肘关节功能障碍的直接原因.最常见原发病因为肱骨远端骨折,其次为肘关节骨折伴脱位、尺骨鹰嘴骨折、单纯肘关节脱位、桡骨头骨折.“,”Objective To evaluate the clinical outcomes of open arthrolysis combined with hinged external fixator for treatment of elbow stiffness,and investigate the common etiologies in patients with elbow joint dysfunction to provide guidance for prevention and treatment.Methods A retrospective review was conducted of 245 cases of elbow joint dysfunction that were treated in our hospital between January 2010 and December 2013.Range of motion of the elbow before and after the surgery was compared.The etiologic features and distribution were analyzed.Results Elbow joint range of motion improved from an average of (37 ± 20)°preoperatively to (121 ± 12)°postoperatively.The Mayo Elbow Performance Index (MEPI) increased from an average of 57 ± 10 to 93 ± 7.The differences were statistically significant (P ＜ 0.01).The most common cause of dysfunction of the elbow was trauma which accounted for 90.61％.The five leading etiologies of posttraumatic elbow joint dysfunction were fractures of the distal humerus (34.29％),periarticular fracture dislocations (19.18％),olecranon fractures (17.14％),simple dislocation of the elbow joint (10.61％),and fractures of the radial head (9.39％).Heterotopic bone formation was found in 161 patients (65.71％).Predisposition factors for developing heterotopic ossification included duration of immobilization after the trauma or operation,early rehabilitation,and accompanying traumatic brain injury or burn.Elbow dysfunction caused by simple dislocation of the elbow joint was seen more in female patients than in male patients (P ＜ 0.01).Proliferative synovitis was the most common etiology of non-traumatic elbow joint dysfunction.Conclusion Combination of open arthrolysis and hinged external fixator can increase range of motion of the elbow joint and lead to good outcomes.Trauma to the elbow and subsequent heterotopic ossification are the direct causes for elbow joint dysfunction.Fracture of the distal humerus is the most common primary etiology of elbow joint dysfunction,followed by olecranon fracture,simple dislocation,and radial head fracture.