Objective: To evaluate the mid-term effectiveness of arthrolysis and hinged external fixation for the treatment of stiff elbow caused by heterotrophic ossification.
Methods: Between January 2014 and December 2017, 11 patients with stiff elbow caused by heterotrophic ossification were admitted. There were 9 males and 2 females with an average age of 32 years (range, 14-48 years), and left side in 6 cases and right side in 5 cases. The cause of stiff elbow included humerus fracture in 5 cases, ulna fracture in 2 cases, fracture of capitulum radii in 1 case, dislocation of capitulum radii in 1 case, terrible triad of the elbow in 1 case, and soft tissue injury in 1 case. The disease duration ranged from 7 to 18 months (mean, 11 months). Preoperative active range of motion of elbow was (19.6±17.5)° and Mayo score was 34.1±9.7. All patients received the treatment of arthrolysis and debridement of heterotrophic ossification lesion combining hinged external fixator, and active and passive rehabilitation with the help of hinged external fixator. The hinged external fixators were removed after 2 months.
Results: All patients were followed up 13-36 months (mean, 19.1 months). All incisions healed by first intention, and no complication of infection or nerve lesion occurred postoperatively. At last follow-up, the results of X-ray films showed that no heterotrophic ossification recurred. The active range of motion of elbow was (116.4±16.6)° and Mayo score was 93.2±7.8, showing significant differences when compared with preoperative ones ( t=17.508, P=0.000; t=16.618, P=0.000).
Conclusion: The application of arthrolysis and debridement of heterotrophic ossification lesion combining hinged external fixator can improve the elbow's range of motion significantly and obtain a good mid-term effectiveness.
目的: 探讨肘关节松解联合铰链式外固定架治疗异位骨化所致肘关节屈伸功能障碍的中期疗效。.
方法: 2014 年 1 月—2017 年 12 月，收治 11 例肘关节异位骨化导致的肘关节屈伸功能障碍患者。男 9 例，女 2 例；年龄 14～48 岁，平均 32 岁。左侧 6 例，右侧 5 例。初始病因：肱骨骨折 5 例，尺骨骨折 2 例，桡骨头骨折 1 例，桡骨头脱位 1 例，肘关节恐怖三联征 1 例，肘关节软组织损伤 1 例。术前异位骨化导致肘关节功能障碍 7～18 个月，平均 11 个月。术前肘关节主动屈伸活动度为（19.6±17.5）°，Mayo 评分为（34.1±9.7）分。所有患者采用开放手术松解肘关节关节囊和内、外侧副韧带，清除异位骨化病灶，联合铰链式外固定架固定；术后在铰链式外固定架辅助下行主、被动功能锻炼 2 个月。术后 2 个月去除肘关节外固定架。.
结果: 11 例患者均获随访，随访时间 13～36 个月，平均 19.1 个月。术后切口均Ⅰ期愈合，随访期间未出现明显钉道感染、神经损伤等并发症。末次随访时，X 线片示肘关节无新异位骨化形成。患者肘关节主动屈伸活动度为（116.4±16.6）°，Mayo 评分为（93.2±7.8）分，与术前比较差异均有统计学意义（ t=17.508， P=0.000； t=16.618， P=0.000）。.
结论: 对于异位骨化所致肘关节屈伸功能障碍，肘关节松解联合铰链式外固定架治疗能有效改善肘关节屈伸活动度，获得较好中期疗效。.
Keywords: Elbow; dysfunction; heterotrophic ossification; hinged external fixator; mid-term effectiveness.