肘关节镜下清理术治疗肘关节骨关节炎的早期疗效
发布时间：2018-10-24 21:50
【摘要】：目的：探讨采用肘关节镜下清理术治疗肘关节骨关节炎的早期治疗效果。 方法：2010年5月-2013年5月，收治16例肘关节骨关节炎的患者，男性14例，女性2例。患者年龄22~58岁，平均年龄45岁。其中15例右肘、1例左肘，均为单侧发病。术前常规进行肘关节正侧位X线检查。X线检查如发现肘关节游离体，或者肘关节增生的骨赘较多，则进一步行肘关节CT检查。采用臂丛神经阻滞麻醉行肘关节镜下清理术。采用侧卧位体位，患肢在上，上臂置于托板，前臂自然下垂，屈肘900。上臂应用充气式止血带，先于肘关节后外侧软点处使用无菌注射器穿刺并注入约25mL无菌生理盐水扩张肘关节，然后于后正中入路标记处纵行切开皮肤约1cm，，钝性分离皮下组织及肱三头肌腱，建立第一入路，其余入路均先用腰穿针于体表标记处穿刺，依次建立后外侧入路、近端内侧入路和近端外侧入路作为辅助入路行肘关节镜下清理术，切除增生滑膜，取出游离体，根据术前X线片及CT检查切除增生骨赘，重点切除鹰嘴窝及鹰嘴尖端，肱骨冠突窝、尺骨冠突等处的增生骨赘。术中肘关节做适当屈伸及旋转活动，观察骨赘撞击情况，术中注意于尺神经附近小心操作，避免神经及血管损伤。术后使用弹力绷带予以肘关节加压包扎。术后2~3天开始关节活动度训练及压直练习，逐渐加大屈伸角度，并于活动后冰敷。分别测量术前、术后肘关节伸直角度、屈曲角度、活动度，应用Mayo肘关节功能评分（MEPS）评价疗效，并对术前及术后肘关节的伸直角度、屈曲角度、活动度以及MEPS评分值进行配对t检验，P＜0.05认为有统计学意义。 结果：所有16例患者切口均为甲级愈合，术后均未出现神经以及血管的损伤等并发症。术前肘关节的伸直角度、屈曲角度，肘关节的活动度以及MEPS评分结果分别为23.43±4.95、95.31±3.63、71.88±7.51、42.81±4.11，术后分别为10.00±2.81、110.62±3.70、100.62±5.04、86.25±3.40。术前、术后比较有显著性差异（P0.05）。术后MEPS评分结果：优9例，良4例，中3例。优良率达81.25%。患者主观均满意。 结论：采用肘关节镜下清理术治疗肘关节骨关节炎，可以明显增加肘关节的活动范围，提高肘关节的功能，取得良好的早期治疗效果。采用侧卧位，以后正中入路作为第一入路，辅以后外侧入路、近端内侧入路和近端外侧入路行肘关节镜下清理术，术中操作方便，安全。
[Abstract]:Objective: to investigate the early treatment effect of elbow osteoarthritis by elbow arthroscopy. Methods: from May 2010 to May 2013, 16 cases of elbow osteoarthritis were treated, including 14 males and 2 females. The patients were 22 to 58 years old, with an average age of 45 years. 15 cases of right elbow and 1 case of left elbow were all unilateral. X-ray examination of elbow joint was performed before operation. If the free body of elbow joint was found, or the osteophyte of elbow joint hyperplasia was more, CT examination of elbow joint was carried out further. Brachial plexus block anesthesia was used for elbow arthroscopic debridement. Adopt lateral position, the affected limb is on the top, the upper arm is placed on the plate, the forearm is naturally pendulous, and the elbow is bent 900. An inflatable tourniquet was applied to the upper arm, and a sterile syringe was used to puncture and inject about 25mL aseptic saline to dilate the elbow joint before the soft spot on the posterolateral side of the elbow joint. The first approach was established by separating subcutaneous tissue and triceps tendon obtuse. The other approaches were first punctured with lumbar puncture to mark the body surface, and the posterolateral approach was established in turn. The proximal medial approach and proximal lateral approach were used as auxiliary approaches for elbow arthroscopic debridement, synovial hyperplasia was removed, free body was removed, and osteophytes were removed according to preoperative X-ray and CT examination, and hawks' fossa and the tip of hawks were excised with emphasis on the excision of the olecranon fossa and the tip of the olecranon. A proliferative osteophyte in the coronoid fossa of the humerus and the coronoid process of the ulna. Elbow joint should be inflated and rotated properly during the operation to observe the impact of osteophyte, and to avoid nerve and vascular injury by careful operation near the ulnar nerve during the operation. After operation, elastic bandages were used to compress the elbow joint. Three days after operation, the joint motion training and compression exercises were started, and the angle of flexion and extension was gradually increased, and ice was applied after exercise. Elbow extension angle, flexion angle, range of motion were measured before and after operation. Mayo elbow function score (MEPS) was used to evaluate the curative effect, and the elbow extension angle and flexion angle were evaluated before and after operation. The range of activity and MEPS score were matched t test (P < 0. 05). Results: all the 16 patients had grade A wound healing, and no complications such as nerve and vascular injury were found after operation. The results of extension angle, flexion angle, range of motion of elbow joint and MEPS score were 23.43 卤4.95 卤95.31 卤3.63 卤71.88 卤7.51 卤42.81 卤4.11, 10.00 卤2.1110.62 卤3.70100.62 卤5.086.25 卤3.40 respectively. There was significant difference before and after operation (P0.05). Postoperative MEPS score: excellent in 9 cases, good in 4 cases, moderate in 3 cases. The excellent and good rate is 81.25%. All the patients were satisfied. Conclusion: the treatment of elbow osteoarthritis by elbow arthroscopy can obviously increase the range of elbow motion, improve the function of elbow joint, and obtain good early therapeutic effect. Lateral supine position, posterior median approach as the first approach, assisted by the posterolateral approach, proximal medial approach and proximal lateral approach for elbow arthroscopic debridement, the operation was convenient and safe.
【学位授予单位】：河北医科大学
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R687.4
本文编号：2292657
[Abstract]:Objective: to investigate the early treatment effect of elbow osteoarthritis by elbow arthroscopy. Methods: from May 2010 to May 2013, 16 cases of elbow osteoarthritis were treated, including 14 males and 2 females. The patients were 22 to 58 years old, with an average age of 45 years. 15 cases of right elbow and 1 case of left elbow were all unilateral. X-ray examination of elbow joint was performed before operation. If the free body of elbow joint was found, or the osteophyte of elbow joint hyperplasia was more, CT examination of elbow joint was carried out further. Brachial plexus block anesthesia was used for elbow arthroscopic debridement. Adopt lateral position, the affected limb is on the top, the upper arm is placed on the plate, the forearm is naturally pendulous, and the elbow is bent 900. An inflatable tourniquet was applied to the upper arm, and a sterile syringe was used to puncture and inject about 25mL aseptic saline to dilate the elbow joint before the soft spot on the posterolateral side of the elbow joint. The first approach was established by separating subcutaneous tissue and triceps tendon obtuse. The other approaches were first punctured with lumbar puncture to mark the body surface, and the posterolateral approach was established in turn. The proximal medial approach and proximal lateral approach were used as auxiliary approaches for elbow arthroscopic debridement, synovial hyperplasia was removed, free body was removed, and osteophytes were removed according to preoperative X-ray and CT examination, and hawks' fossa and the tip of hawks were excised with emphasis on the excision of the olecranon fossa and the tip of the olecranon. A proliferative osteophyte in the coronoid fossa of the humerus and the coronoid process of the ulna. Elbow joint should be inflated and rotated properly during the operation to observe the impact of osteophyte, and to avoid nerve and vascular injury by careful operation near the ulnar nerve during the operation. After operation, elastic bandages were used to compress the elbow joint. Three days after operation, the joint motion training and compression exercises were started, and the angle of flexion and extension was gradually increased, and ice was applied after exercise. Elbow extension angle, flexion angle, range of motion were measured before and after operation. Mayo elbow function score (MEPS) was used to evaluate the curative effect, and the elbow extension angle and flexion angle were evaluated before and after operation. The range of activity and MEPS score were matched t test (P < 0. 05). Results: all the 16 patients had grade A wound healing, and no complications such as nerve and vascular injury were found after operation. The results of extension angle, flexion angle, range of motion of elbow joint and MEPS score were 23.43 卤4.95 卤95.31 卤3.63 卤71.88 卤7.51 卤42.81 卤4.11, 10.00 卤2.1110.62 卤3.70100.62 卤5.086.25 卤3.40 respectively. There was significant difference before and after operation (P0.05). Postoperative MEPS score: excellent in 9 cases, good in 4 cases, moderate in 3 cases. The excellent and good rate is 81.25%. All the patients were satisfied. Conclusion: the treatment of elbow osteoarthritis by elbow arthroscopy can obviously increase the range of elbow motion, improve the function of elbow joint, and obtain good early therapeutic effect. Lateral supine position, posterior median approach as the first approach, assisted by the posterolateral approach, proximal medial approach and proximal lateral approach for elbow arthroscopic debridement, the operation was convenient and safe.
【学位授予单位】：河北医科大学
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R687.4
【引证文献】
相关期刊论文 前1条
1 腾高玲;;试论清理松解术治疗晚期原发性肘关节骨关节炎的临床应用[J];世界最新医学信息文摘;2016年88期
本文编号：2292657
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