前内侧肌间隙入路松解治疗退变性肘关节僵硬的临床探索

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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.

Key words： muscle space approach degenerative elbow stiffness

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［1］Morrey BF，Askew LJ，Chao EY.A biomechanical study of normal functional elbow motion［J］.J Bone Joint Surg(Am)，1981，63(6)：872-877.
［2］Kay N.Arthrolysis of the post-traumatic stiff elbowSurgery of the Elbow［M］.London：Aronld，1998：228-234.
［3］Stehle J，Gohlke F.Classification of elbow stiffness and indications for surgical treatment［J］.J Orthopade，2011，40(4)：282-290.
［4］Morrey BF.Post-traumatic contracture of the elbow.Operativetreatment，including distraction arthroplasty［J］.J Bone Joint Surg (Am)，1990，72(4)：601-618.
［5］贺韬，张云辉，李亘，等.肘关节前内侧入路治疗冠状突骨折的解剖学研究及临床应用［J］.中华创伤骨科杂志，2017，19(7)：559-565.
［6］杨明，张殿英，付中国，等.开放肘关节松解术治疗17例肘关节僵硬患者［J］.北京大学学报(医学版)，2012，44(6)：870-873.
［7］Mansat P，Morrey BF.The column procedure：a limited lateral approach for extrinsic contracture of the elbow［J］.J Bone Joint Surg (Am)，1998，80(11)：1603-1615.
［8］Cohen MS，Hastings H.Post-traumatic contracture of the elbow.Operative release using a lateral collateral ligament sparing approach［J］.J Bone Joint Surg(Br)，1998，80(5)：805-812.
［9］Vardakas DG，Varitimidis SE，Goebel F，etal.Evaluatingandtreating the stiff elbow［J］.Hand Clin，2002，18(1)：77-85.
［10］Kasparyan NG，Hotchkiss RN.Dynamic skeletal fixation in the upper Extremity［J］.Hand Clin，1997，13(4)：643-663.
［11］杨小华.肘前内侧神经血管间隙入路的解剖研究及临床应用［D］.河北医科大学，2017.
［12］高鹏，李翰鹏，姜磐.肘关节开放松解术联合外固定支架治疗肱骨骨折术后肘关节僵硬疗效的前瞻性研究［J］.中国骨与关节杂志，2017，6(11)：806-809.
［13］Kruse KK.Papatheodorou LK，Weiser RW，et al.Release of the stiff elbow with mini-open technique［J］.J Shoulder Elbow Surg，2016，25(3)：355-361.
［14］顾三军，李海峰，孔友谊，等.小切口治疗创伤性肘关节僵直的体会［J］.中国骨与关节损伤杂志，2010，25(5)：473-474.
［15］Krishnan SG，Harkins DC，Pennington SD，et al.Arthroscopiculnohumeralarthroplasty for degenerative arthritis of the elbow in patients under fifty years of age［J］.J Shoulder Elbow Surg，2007，16(4)：443-448.
［16］CefoI，Eygendaal D.Arthroscopicathrolysis for posttraumatic elbow stiffness［J］.J Shoulder Elbow Surg，2011，20(3)：434-439.
［17］Kelly EW，Morrey BF，O'Driscoll SW.Complications of elbowarthroscopy［J］.J Bone Joint Surg(Am)，2001，83(1)：25-34.
［18］Elfeddali R，Schreuder MH，Eygendaal D.Arthroscopic elbow surgery，is it safe?［J］.J Shoulder Elbow Surg，2013，22(5)：647-652.
［19］张云辉.肘关节改良内侧入路治疗冠状突骨折的解剖学研究及应用［D］.上海交通大学，2015：1-55.
［20］Wada T，Ishii S，Usui M，et al.The medial approach for operative re-lease of post-traumatic contracture of the elbow［J］.J Bone Joint Surg(Br)，2000，82(1)：68-73.
［21］何劲，范存义.切开松解术联合铰链式外固定支架治疗极重度肘关节僵硬疗效分析［J］.国际骨科学杂志，2014，35(3)：189-192.
［22］Williams BG，Sotereanos DG，Baratz MF，etal.Thecontractedelbow：is ulnar nerve release necessary?［J］.J Shoulder Elbow Surg，2012，21(12)：1632-1636.