Abstract:Objective To explore the clinical application of the anteromedial approach in the treatment of degenerative elbow stiffness.Methods From August 2016 to August 2019,19 cases of degenerative elbow stiffness were treated using the anteromedial elbow approach through the intramuscular space between the pronator teres and the flexor carpiradialis.There were 15 males and 4 females,aged 43~62 years,with an average age of (53.6±1.2)years.There were 13 cases of right elbow and 6 of left,in which 15 cases were the main side,and 11 cases combined with ulnar nerve compression symptoms.The course of disease ranged from 4 months to 5 years,with an average of (3.5±0.5)years.Rehabilitation exercise was guided postoperation,and the curative effect was evaluated using Mayo elbow performance score(MEPS) and VAS score.Results The wounds healed by first intention in all 19 cases.The average follow-up time was(11.3±0.8)months (3 to 24 months),and all 19 cases were followed up.3 months after surgery,the MEPS and VAS score were both statistically significant compared to that preoperative(P<0.001).According tothe MEPS,11 were excellent,6 were good and 2 was fair,andthe cure rate was 89.47%.The flexion increased to(127.63±5.79)°,and the extension restriction improved to (9.74±3.90)°,the difference was statistically significant(P<0.001) compared with(101.21±12.45)° and (27.63±8.72)° preoperative.Forearm rotation was also improved in all cases.In the 3th month follow-up,the mean increase in flexion and extension radians was(44.37±12.09)°,and all patients got a range of motion that could meet the demand in daily life.Except for one patient who had no ulnar nerve compression symptoms preoperative,a transient ulnar nerve palsy occurred after the surgury,which had been cured by conservative treatment.No serious complications occurred.Conclusion The anteromedial approach through the intramuscular space between the pronator teres and the flexor carpi radialis is a reliable and safe access for the treatment of degenerative elbow stiffness.In addition,the learning curve is short and the risk of surgery is low,which makes it easier to perform in hospitals at all levels.
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