Short-term Results Of Elbow Debridement Under Arthroscopy In Patients With Elbow Osteoarthritis

Objective：To evaluate the short-term results of elbow debridementunder arthroscopy in patients with elbow osteoarthritis.Method: Between May2010and May2013, there were16patientswith elbow osteoarthritis (male14, female2). The average age was45years old (range22-58years).15cases were affected with right side,1case was affected with left side. All cases were unilaterally affected.X-ray examination of elbow joint was taken before operation. If X-rayshowed there were loose body in the elbow, or osteophytes were severe,then CT scan of elbow was taken. The elbow debridement underarthroscopy was performed after the brachial plexus block anesthesia.The lateral position was used. The affected limb was placed on the pallet.The forearm was dropped naturally, with the elbow bending in900flexion.Pneumatic tourniquet was used. Sterile syringe was used to puncture atthe soft point of elbow, and about25ml sterilized saline was injected intothe elbow. The skin was incised longitudinally at the marked point of theposterior median approach. The subcutaneous tissue and the tricepstendon were separated bluntly. Then the posterior median portal wasestablished as the first portal. Other portals were established at the markswith the help of lumbar puncture needle. The posterolateral portal, theproximal medial portal and the proximal lateral portal were used toperform the elbow arthroscope debridement (including synovectomy,loose body removal, osteophytes resection etc). The osteophytes wereresected according to the preoperative X-ray and CT, focusing on theosteophytes of the olecranon fossa, the tip of the olecranon, the Coronoidfossa of the humerus, and the ulna coronoid process. The elbow joint wasflexed and extended to observe the impact of osteophytes during operation. More attention should be paid to avoid nerve and blood vesselinjury. The elbow was pressured by elastic bandages after operation.Rehabilitation was began2~3days after operation, including elbowflexion and extension. Ice compress was given after practice. Elbowextension angle, flexion angle, range of motion were measuredpreoperatively and postoperatively. Mayo Elbow Performance Score(MEPS) was used to evaluate the therapeutic effect. All above wereanalyzed by paired t-test, and the results were considered to havestatistical significance when P<0.05.Result: All the16patients were followed up for14months (range6~30months). All incisions healed by first intention. There were nocomplications of nerve and blood vessel injury. Before operation, theelbow extension angle, flexion angle, range of motion and MEPS were23.43±4.95,95.31±3.63,71.88±7.51,42.81±4.11. After operation, theywere10.00±2.81,110.62±3.70,100.62±5.04,86.25±3.40respectively.They were significantly improved when compared with those beforeoperation (P<0.05). At the end of the follow-up, the MEPS resultsshowed: excellent in9cases, good in4cases, fair in3cases. Theexcellent and good rate was81.25%. All the patients were satisfied withthe results.Conclusion: The arthroscopic debridement is an effective techniqueto treat the patients with elbow osteoarthritis, which can obviouslyimprove the range of motion and the function of elbow joint, and hasgood short-term results. The operation is convenient and safe when usinglateral position, posterior median portal as the first portal, combined theposterolateral portal, the proximal medial portal and the proximal lateralportal.