發(fā)布時間：2018-10-24 21:50

【摘要】：目的：探討采用肘關節(jié)鏡下清理術治療肘關節(jié)骨關節(jié)炎的早期治療效果。 方法：2010年5月-2013年5月，收治16例肘關節(jié)骨關節(jié)炎的患者，男性14例，女性2例�；颊吣挲g22~58歲，平均年齡45歲。其中15例右肘、1例左肘，均為單側發(fā)病。術前常規(guī)進行肘關節(jié)正側位X線檢查。X線檢查如發(fā)現(xiàn)肘關節(jié)游離體，或者肘關節(jié)增生的骨贅較多，則進一步行肘關節(jié)CT檢查。采用臂叢神經阻滯麻醉行肘關節(jié)鏡下清理術。采用側臥位體位，患肢在上，上臂置于托板，前臂自然下垂，屈肘900。上臂應用充氣式止血帶，先于肘關節(jié)后外側軟點處使用無菌注射器穿刺并注入約25mL無菌生理鹽水擴張肘關節(jié)，然后于后正中入路標記處縱行切開皮膚約1cm，，鈍性分離皮下組織及肱三頭肌腱，建立第一入路，其余入路均先用腰穿針于體表標記處穿刺，依次建立后外側入路、近端內側入路和近端外側入路作為輔助入路行肘關節(jié)鏡下清理術，切除增生滑膜，取出游離體，根據(jù)術前X線片及CT檢查切除增生骨贅，重點切除鷹嘴窩及鷹嘴尖端，肱骨冠突窩、尺骨冠突等處的增生骨贅。術中肘關節(jié)做適當屈伸及旋轉活動，觀察骨贅撞擊情況，術中注意于尺神經附近小心操作，避免神經及血管損傷。術后使用彈力繃帶予以肘關節(jié)加壓包扎。術后2~3天開始關節(jié)活動度訓練及壓直練習，逐漸加大屈伸角度，并于活動后冰敷。分別測量術前、術后肘關節(jié)伸直角度、屈曲角度、活動度，應用Mayo肘關節(jié)功能評分（MEPS）評價療效，并對術前及術后肘關節(jié)的伸直角度、屈曲角度、活動度以及MEPS評分值進行配對t檢驗，P＜0.05認為有統(tǒng)計學意義。 結果：所有16例患者切口均為甲級愈合，術后均未出現(xiàn)神經以及血管的損傷等并發(fā)癥。術前肘關節(jié)的伸直角度、屈曲角度，肘關節(jié)的活動度以及MEPS評分結果分別為23.43±4.95、95.31±3.63、71.88±7.51、42.81±4.11，術后分別為10.00±2.81、110.62±3.70、100.62±5.04、86.25±3.40。術前、術后比較有顯著性差異（P0.05）。術后MEPS評分結果：優(yōu)9例，良4例，中3例。優(yōu)良率達81.25%�；颊咧饔^均滿意。 結論：采用肘關節(jié)鏡下清理術治療肘關節(jié)骨關節(jié)炎，可以明顯增加肘關節(jié)的活動范圍，提高肘關節(jié)的功能，取得良好的早期治療效果。采用側臥位，以后正中入路作為第一入路，輔以后外側入路、近端內側入路和近端外側入路行肘關節(jié)鏡下清理術，術中操作方便，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 鹵4.95 鹵95.31 鹵3.63 鹵71.88 鹵7.51 鹵42.81 鹵4.11, 10.00 鹵2.1110.62 鹵3.70100.62 鹵5.086.25 鹵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.
【學位授予單位】：河北醫(yī)科大學
【學位級別】：碩士
【學位授予年份】：2014
【分類號】：R687.4

【引證文獻】

相關期刊論文 前1條

1 騰高玲;;試論清理松解術治療晚期原發(fā)性肘關節(jié)骨關節(jié)炎的臨床應用[J];世界最新醫(yī)學信息文摘;2016年88期

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