合并异位骨化创伤后肘关节僵硬的治疗技术总结.doc

合并异位骨化创伤后肘关节僵硬的治疗 唐金树　杨润功　胡鸢　石秀秀　吴闻文　侯树勋 作者单位：100048 北京，解放军总医院第一附属医院骨科 【摘要】　目的　探讨合并异位骨化的创伤后肘关节僵硬的外科治疗、术后康复及异位骨化的预防。 方法　自2007年１月至2009年６月共收治15例合并异位骨化的创伤后肘关节僵硬，且不能通过康复和支具治 疗恢复关节功能的患者，其中男11例，女４例，年龄21～62岁，平均37.9岁，僵硬时间8-20个月，平均13.6个 月。损伤类型：尺骨鹰嘴骨折术后３例；肱骨中下段骨折术后６例；肱骨外髁骨折并肘关节脱位术后１例； 肘关节软组织伤２例；全身烧伤后并发肘关节异位骨化及僵硬３例。异位骨化程度按Brooker分类，Ｉ型，２ 例；II型，４例；III型，６例；IV型，３例。治疗前屈伸活动范围0°～50°，平均26°；关节功能评分44～59 分，平均51分。对此15例患者应用外科手术切除异位骨和关节松解，术后结合康复治疗同时综合应用放疗、 口服布洛芬和改进手法关节活动度训练方法预防异位骨化。治疗后测定肘关节屈伸活动范围和进行关节功能 评分，并对比观察治疗前后变化，Ｘ线片检查评价异位骨化的复发情况。结果　经手术治疗及术后系统康复 后关节屈伸活动范围明显增加，关节功能明显改善。随访24-52个月，平均33.9个月。治疗后肘关节屈伸活动 范围85°～140°，平均111°；关节功能评分84～100分，平均91分。与治疗前相比，肘关节屈伸活动范围和关节 功能评分明显增加，两者差异均有统计学意义(P＜0.01)。随访期内Ｘ线片检查未见异位骨复发。结论　应用 手术切除异位骨及关节松解结合术后康复和异位骨化的预防可以有效治疗经保守治疗无效的合并异位骨化的 创伤后肘关节僵硬，明显改善关节功能。 【关键词】　创伤后肘关节僵硬；异位骨化；外科治疗；早期康复 DOI: 10.3969/j.issn.2095-252X.2012.05.007　　中图分类号：R684, R493 Treatment of posttraumatic stiffness of the elbow with heterotopic ossiication TANG Jinshu, YANG Rungong, HU Yuan, SHI Xiuxiu, WU Wenwen, HOU Shuxun. Department of Orthopedics, The First Afiliated Hospital of the General Hospital of People’s Liberation Army, Beijing, 100048, PRC 【Abstract】 Objective To investigate the surgical treatment, postoperative rehabilitation and prevention of heterotopic ossiication (HO) of posttraumatic stiffness of the elbow with HO. Methods From January 2007 to June 2009, 15 patients with posttraumatic stiffness of the elbow with HO, whose elbow function could not get recovered through rehabilitation or with orthosis, were adopted, including 11 males and 4 females. The mean age was 37.9 years old (range; 21-62 years). The average stiffness time was 13.6 months (range; 8-20 months). The types of injuries included 3 cases of olecranon fractures, 6 cases of middle and distal humeral fractures, 1 case of fracture of the lateral condyle of the humerus accompanied with elbow dislocation, 2 cases of soft tissue injuries around the elbow, and 3 cases of elbow stiffness with HO secondary to full body