Clinical effect of arthroscopic combined with open release in the treatment of severe and extremely severe post-traumatic elbow stiffness / 中华骨科杂志

ABSTRACT

Objective:To investigate the therapeutic effect of arthroscopic combined with open release in the treatment of severe post-traumatic elbow stiffness.Methods:Data of 32 patients with severe post-traumatic elbow stiffness treated by arthroscopy combined with open release from January 2016 to September 2019 were retrospectively analyzed, including 13 males and 19 females. Age 38.5±15.6 years (range, 17-66 years). For the original trauma, there were 12 cases of distal humeral fractures, 8 cases of radial head fractures, 8 cases of horrible triad of elbow, 2 cases of anterior dislocation of elbow through olecranon fracture, 1 case of Monteggia fracture, and 1 case of olecranon fracture. The range of motion (ROM), Mayo elbow performance score (MEPS) and visual analogue scale (VAS) of elbow joint at pre-operation, 6 months post-operation and the last follow-up were recorded and compared to evaluate the clinical effect of this operation on severe post-traumatic elbow stiffness.Results:The average operation time was 114.1±27.5 min (range, 70-170 min). Two patients developed mild ulnar nerve symptoms after operation, which were relieved after oral mecobalamin. The follow-up time was 38.5±14.4 months (range, 25-69 months). For elbow extension to flexion ROM, it was 47.66°±12.05° at pre-operation, 93.75°±12.89° at 6 months post-operation, and 106.88°±17.68° at the last follow-up, the differences were statistically significant ( F=148.87, P<0.001). For elbow rotation ROM, it was 132.19°±22.68° at pre-operation, 141.88°±21.91° at 6 months post-operation and 149.38°±23.27° at the last follow-up, and the differences were statistically significant ( F=4.64, P=0.012). At 6 months post-operative, the extension to flexion ROM of the elbow was significantly higher than that of pre-operation ( P<0.05); The rotation ROM was higher than that of pre-operation, but the difference was not statistically significant. At the last follow-up, the extentsion to flexion ROM and the rotation ROM were both significantly higher than those of pre-operation ( P<0.05). At the last follow-up, the VAS and MEPS were 1.38±0.94 and 93.44±5.15 respectively, which were significantly improved compared with those of pre-operation 3.91±1.09 and 37.97±7.71 ( P <0.001). Conclusion:Arthroscopic combined with open release in the treatment of severe post-traumatic elbow stiffness can significantly increase the elbow ROM and functional score as well as significantly relieve the pain of the elbow. It can effectively release the elbow while keeping it minimal invasive, and maintain the stability of the elbow to the maximum, with reliable efficacy.