關(guān)節(jié)鏡下治療肘關(guān)節(jié)骨性關(guān)節(jié)炎的效果分析

楊葉鋒++梁樹威++勞貴昌++林樹體

【摘要】目的 觀察關(guān)節(jié)鏡下治療肘關(guān)節(jié)骨性關(guān)節(jié)炎的效果。方法選擇收治的31例肘關(guān)節(jié)骨性關(guān)節(jié)炎患者，均采用關(guān)節(jié)鏡技術(shù)進(jìn)行治療，觀察手術(shù)前后活動(dòng)范圍情況，記錄手術(shù)前、術(shù)后3個(gè)月、術(shù)后6個(gè)月時(shí)患者最大屈曲度和最大伸直度；采用Mayo評(píng)分系統(tǒng)對(duì)比術(shù)后3個(gè)月、術(shù)后6個(gè)月的療效。結(jié)果所有患者均順利完成手術(shù)，切口均Ⅰ期愈合。所有患者均獲得隨訪，隨訪時(shí)間為6～12個(gè)月，平均8.5個(gè)月。術(shù)后3個(gè)月、術(shù)后6個(gè)月時(shí)兩組療效比較差異無統(tǒng)計(jì)學(xué)意義（P>0.05）。術(shù)前、術(shù)后3個(gè)月、術(shù)后6個(gè)月時(shí)的最大屈曲度、最大伸直度、Mayo評(píng)分比較差異均有統(tǒng)計(jì)學(xué)意義（P<0.01），術(shù)后3個(gè)月、術(shù)后6個(gè)月時(shí)的最大屈曲度、最大伸直度、Mayo評(píng)分較術(shù)前顯著改善（P<0.01），術(shù)后3個(gè)月、術(shù)后6個(gè)月時(shí)的最大屈曲度、最大伸直度、Mayo評(píng)分比較差異無統(tǒng)計(jì)學(xué)意義（P>0.05）。術(shù)后均未出現(xiàn)明顯的并發(fā)癥，無術(shù)后血管神經(jīng)損傷發(fā)生。結(jié)論關(guān)節(jié)鏡手術(shù)是治療肘關(guān)節(jié)骨性關(guān)節(jié)炎的有效方法，能明顯改善術(shù)后肘關(guān)節(jié)功能，安全性高，值得臨床推廣。

【關(guān)鍵詞】肘關(guān)節(jié)；骨性關(guān)節(jié)炎；關(guān)節(jié)鏡；關(guān)節(jié)清理；肘關(guān)節(jié)功能

中圖分類號(hào)：R684.3 文獻(xiàn)標(biāo)識(shí)碼：ADOI：10.3969/j.issn.10031383.2015.06.013

Effectiveness analysis of arthroscopic treatment for elbow joint osteoarthritis

YANG Yefeng，LIANG Shuwei，LAO Guichang，LIN Shuti

（The First Peoples Hospital of Qinzhou，Qinzhou 535000，Guangxi，China）

【Abstract】ObjectiveTo observe the effectiveness of arthroscopic treatment for elbow joint osteoarthritis.Methods31 patients with elbow joint osteoarthritis were treated by arthroscopic technique.Range of motion（ROM） before and after treatment were compared.Maximum flexibility and straightness before surgery，3 months and 6 months after surgery were recorded.In addition，Mayo scoring system was applied to compare effectiveness 3 months and 6 months after surgery.Results The operation was completed successfully in all patients，and incisions healed in the first intention.All cases were followed up for 6 to 12 months （mean 8.5 months）.Difference of effectiveness 3 months and 6 months after surgery was not statistically significant（P>0.05）.Difference of maximum flexibility and straightness before surgery，3 months and 6 months after surgery as well as Mayo score was statistically significant（P<0.01）.Maximum flexibility and straightness 3 months and 6 months after surgery as well as Mayo score significantly improved，and difference was not statistically significant（P>0.05）.No obvious complications and neurovascular damage were found after operation.ConclusionArthroscopic operation is an efficacy method in the treatment of elbow joint osteoarthritis，which can obviously improve the elbow joint functions with high security.Thus，it is worthy of clinical application.

【Key words】elbow joint osteoarthritis；arthroscope；joint debridement；elbow joint function

骨性關(guān)節(jié)炎以膝關(guān)節(jié)、髖關(guān)節(jié)、手指等部位多見，肘關(guān)節(jié)較為少見。肘關(guān)節(jié)骨性關(guān)節(jié)炎病理上表現(xiàn)為炎性或瘢痕化滑膜形成并卡壓于關(guān)節(jié)間隙內(nèi)以及異常骨結(jié)構(gòu)形成，導(dǎo)致患者肘關(guān)節(jié)活動(dòng)受限、疼痛等，主要發(fā)生于從事重體力勞動(dòng)及反復(fù)使用上肢的中年男性，患者多有肘關(guān)節(jié)過度使用史[1]。傳統(tǒng)的開放性手術(shù)暴露范圍大、周圍軟組織剝離廣泛，破壞大、出血量多、并發(fā)癥多，肘關(guān)節(jié)功能恢復(fù)受到影響。肘關(guān)節(jié)鏡下微創(chuàng)手術(shù)能明顯減少開放性手術(shù)造成的創(chuàng)傷，近年來也逐漸嘗試運(yùn)用于肘關(guān)節(jié)骨性關(guān)節(jié)炎的治療，并且效果明顯[2]。我科2012年1月～2014年10月對(duì)31例肘關(guān)節(jié)骨性關(guān)節(jié)炎患者實(shí)施了關(guān)節(jié)鏡下關(guān)節(jié)清理術(shù)，療效滿意，現(xiàn)報(bào)告如下。endprint