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中华老年骨科与康复电子杂志

中华老年骨科与康复电子杂志 ›› 2024, Vol. 10 ›› Issue (05) : 257 -263. doi: 10.3877/cma.j.issn.2096-0263.2024.05.001

上肢骨折

改良松解术治疗创伤后肘关节僵硬的疗效及危险因素分析
肖丹1, 陈辰1, 查晔军1, 公茂琪1, 花克涵1, 孙伟桐1, 蒋协远1,†()   
  1. 1. 100035　北京，首都医科大学附属北京积水潭医院创伤骨科
  • 收稿日期:2023-11-01 出版日期:2024-10-05
  • 通信作者: 蒋协远
  • 基金资助:
    北京积水潭医院"学科骨干"计划专项经费(XKGG202101)

Clinical prognosis and risk factors of post-traumatic elbow stiffness treated by modified elbow arthrolysis

Dan Xiao1, Chen Chen1, Yejun Zha1, Maoqi Gong1, Kehan Hua1, Weitong Sun1, Xieyuan Jiang1,†()   

  1. 1. Department of Orthopedic trauma, Beijing Jishuitan Hospital, Capital Medical University, Beijing 10035, China
  • Received:2023-11-01 Published:2024-10-05
  • Corresponding author: Xieyuan Jiang
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肖丹, 陈辰, 查晔军, 公茂琪, 花克涵, 孙伟桐, 蒋协远. 改良松解术治疗创伤后肘关节僵硬的疗效及危险因素分析[J]. 中华老年骨科与康复电子杂志, 2024, 10(05): 257-263.

Dan Xiao, Chen Chen, Yejun Zha, Maoqi Gong, Kehan Hua, Weitong Sun, Xieyuan Jiang. Clinical prognosis and risk factors of post-traumatic elbow stiffness treated by modified elbow arthrolysis[J]. Chinese Journal of Geriatric Orthopaedics and Rehabilitation(Electronic Edition), 2024, 10(05): 257-263.

目的

分析改良肘关节松解术治疗创伤后肘关节僵硬（PTES）的临床预后，探究影响预后的危险因素。

方法

回顾性收集2018年6月至2021年1月于我院行改良松解术的PTES患者的临床资料。首先，对患者术前及末次随访功能进行比较分析；随后，根据末次随访关节活动度将患者分为预后良好和预后不良两组，通过多因素分析，探究导致预后不良的危险因素。

结果

本研究纳入了127例患者，男77例，女50例，平均年龄（36.9±12.3）岁，平均随访时间（22.7±10.8）个月（12~45个月）。末次随访肘关节屈伸活动度较术前增加70.8°，前臂旋转活动度较术前增加14.3°；MEPS评分较术前增加30.0分；DASH评分较术前减少25.0分，VAS评分较术前减少0.0分。通过多因素分析，青少年、中老年、肥胖、主利手侧、原始开放损伤、受伤至松解时间超过2年，以及术前存在PTOA为PTES行改良松解术预后不良的独立危险因素。

结论

改良松解术治疗PTES，总体可获得相对满意的临床预后。年龄、肥胖、主利手侧、原始开放损伤、受伤至松解时间过长，以及术前存在PTOA为PTES行改良松解术预后不良的危险因素。

关键词: 创伤后肘关节僵硬, 开放肘关节松解术, 临床预后, 多因素分析
Objectives

To analyze the clinical prognosis of modified elbow arthrolysis in the treatment of post-traumatic elbow stiffness (PTES), and to analyse the prognostic risk factors of OEA.

Methods

We retrospectively collected the clinical data of patients with PTES at our institution between June 2018 and January 2021. Firstly, we compared the functional outcomes before surgery and at the last follow-up. Secondly, based on the elbow ROM, we divided the patients into two groups, identified the risk factors that affect the prognosis using multivariate logistic regression.

Results

The data of 127 patients(77 males, 50 females) of PTES was collected. The mean age is (36.9±12.3) years. The mean follow-up time is 22.7±10.8 months (12-45 months). At the last follow-up, the ROM of flexion and extension increased 70.8° than that before surgery, the ROM of the forearm rotation increased 14.3°, the MEPS increased 30.0, the DASH decreasd 25.0, and the VAS decreasd to 0.0 (0.0, 3.0). Through the multivariate analysis, the adolescent, middle and elderly patients, obesity, the dominant arm, the initial open fracture, the time from the initial injury to the OEA, and having PTOA before OEA were the independent risk factors that affect the prognosis.

Conclusions

Modified elbow arthrolysis can get good prognosis in the treatment of PTES. Age, obesity, the dominant arm, the initial open fracture, the time from the initial injury to the OEA, and having PTOA before OEA were the independent risk factors that affect the prognosis.

Key words: Post-traumatic elbow stiffness, Open elbow arthrolysis, Clinical prognosis, Multivariate analysis
图1 应用肘关节铰链式外固定架。若术中发现肘关节不稳定，可加装Stryker肘关节铰链式外固定架（33岁男性，尺骨鹰嘴骨折术后肘关节僵硬，行开放肘关节松解术联合外固定架治疗）
图2 51岁女性，1年前摔倒致左桡骨头骨折，于外院行切开复位内固定术，术后肘关节活动受限，于我院行肘关节松解术，末次随访肘关节屈伸活动度133(0~13.1～146.1）°，前臂旋转活动度141.3(53.5~0~87.8）°；a：术前肘关节正侧位X线；b：术前体位照；c：末次随访肘关节正侧位X线；d：末次随访体位照
表1 纳入单因素分析的临床资料
类别 因素
基线资料 年龄，BMI，性别，侧别
初始损伤资料 损伤能量，初始损伤诊断，是否开放，是否手术治疗，是否制动超过2周，是否行暴力被动康复
术前功能 术前屈伸ROM，旋转ROM，MEPS评分，DASH评分，VAS评分，术前神经症状，术前PTOA情况
围手术期资料 受伤至松解时间，手术切口，使用外固定架，术前放疗，服用氨糖美辛
表2 改良肘关节松解术治疗127例创伤后肘关节僵硬患者术前及末次随访功能对比[°，M（P25，P75）]
指标 术前 末次随访 改善程度 Z值 P值
屈伸ROM 28.1（0，52.5） 113.7（92.5，126.5） 70.8（49.4，110.9） 9.705 <0.001
旋转ROM 133.7（96.1，157.3） 151.0（131.3，163.0） 14.3（0.4，36.6） 6.698 <0.001
表3 改良肘关节松解术治疗127例创伤后肘关节僵硬患者预后的多因素分析结果
危险因素 β SE OR值 95% CI P值
年龄 青少年（<21岁） 3.231 1.007 19.529 3.200，119.181 0.001
中老年（≥40岁） 1.823 0.509 4.638 1.652，13.023 0.004
BMI（kg/m2） 24～28 1.452 0.500 4.261 1.543，11.769 0.005
>28 1.983 0.994 9.616 1.299，71.206 0.027
主利手侧 1.010 0.530 2.670 1.035，6.892 0.042
初始开放损伤 1.375 0.758 4.183 1.193，14.665 0.025
受伤至松解时间>24月 1.872 0.793 6.451 1.501，27.728 0.012
术前合并PTOA 1.216 0.510 3.564 1.265，10.042 0.016
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