创伤性僵直肘的手术治疗宋炎成
肘关节,,铰链外固定支架；肘关节；创伤；僵硬,1临床资料和方法,2讨论,参考文献：
摘要：[目的]初步探讨应用铰链外固定支架辅助手术治疗僵直肘的治疗效果。[方法]根据影像学资料、肘关节屈伸障碍的位置，选择恰当的手术时机，采用内、外侧或联合手术入路，保留主要韧带的主要部分，彻底清除影响肘关节活动的异化骨、挛缩的筋膜、次要韧带和关节囊，恢复关节活动度，用铰链外固定支架固定肘关节，术后早期康复锻炼。手术前后采用Mayo肘关节评分标准。[结果]平均随访时间2.5a(13个月～3.5a)，所有患者关节活动度从术前平均42°提高到术后最近复查的100°，Mayo评分由术前平均53分增加到85分(P<0.05)，84.2%的患者关节功能得到明显改善，无肘关节不稳定情况出现。[结论]应用铰链外固定支架辅助手术治疗创伤性僵直肘，能提高手术后肘关节侧方稳定性，使韧带无张力下修复，保证肘关节早期功能锻炼，动静结合促进肘关节功能的康复。关键词：铰链外固定支架；肘关节；创伤；僵硬
Operative treatment of posttraumatic elbow stiffness: evaluation and outcome
SONG Yancheng, HUANG Fuguo, YANG Xiaoning, et al.
Department of Orthopaedics, West China Hospital of Sichuan University, Chengdu 610041
Abstract：[Objective]To investigate the therapeutic efficacy of the hinged external fixator to assist the arthrolysis for the posttraumatic stiff elbows.[Method]According to imageology data and the position of disabled elbow, all stiff elbows were treated surgically though medial, lateral or combined approaches in correct operative time. To retain the range of motion, the heteotopic osteophytes, contracture minor ligaments, capsule and fibrous were get rid of thoroughly while the major ligaments were preserved. Then the elbows were fixed by the hinged fixators, and functional exercise were begun immediately after operation. Preoperative and postoperative scoring was done by Mayo elbowperformance index.[Result]The average followup period was 2.5 years. The mean ROM of the 37 cases of elbow stiffness was 42° before operation and 100° after operation. The mean Mayo score was 53 before operation, compared with 85 after operation. That showed a significant difference (P < 0.05). No elbow instability appeard.[Conclusion]The operation in combination with the hinged external fixator will enhance lateral stability of elbows, provide stable environment for ligments healing, allow early movement of the elbow during healing, then finally improve the function of elbows. ......
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