| Part 1:ANALYSIS OF THE EFFICACY AND SAFETY OF OPEN ARTHROLYSIS COMBINED WITH MODIFIED HINGED EXTERNAL FIXATOR FOR THE TREATMENT OF ELBOW STIFFNESS ObjectiveCombination of open arthrolysis and elbow joint hinged external fixator has been shown to improve the joint motion of the elbow effectively,but the traditional fixation with hinged external fixator has a higher incidence of complications.In order to reduce complications caused by external fixators,the method of fixation with external fixators has been improved,which makes the fixator fixated in distal radius instead of the middle segments of ulnae traditionally.The objective of this study is to evaluate and report the effectiveness and safety of the modified procedure.MethodsA total of 60 patients with elbow stiffness who were scheduled to undergo surgery in our hospital from September 2014 to September 2015 were selected and treated with open arthrolysis combined with modified hinged external fixator.Patients were preoperatively examined in detail,followed up and well recorded;routine ulnar nerve neurolysis and lateral collateral ligament repair were performed intraoperatively;after completion of neurolysis,external fixators were fixated in the distal radius and proximal humerus;assisted by external fixation,elbow joint functional exercise was done by postoperative patients;the external fixation device was removed without anesthesia at postoperative 6weeks and patients were assisted with wrist joint function exercise.Statistics of theextension angle,flexion angle,average elbow flexion and extension activity and forearm rotation angle were made;and the functional evaluation was performed using the Mayo elbow performance score(MEPS)and the Mayo wrist score.ResultsThe pre-and post-operative extension angle,flexion angle and average elbow flexion and extension activity had statistically significant differences [(52.4±10.3)° VS(8.1±2.3)°,(60.5±9.5)° VS(128.1±22.8)°,(13.0±4.4)° VS(119.4±10.2)°,P<0.01].At the last follow-up,there was no significant difference between the pre-and post-operative forearm rotation angle [(148.6±16.2)VS(148.8±12.8),P>0.01].The Mayo elbow performance score was increased from preoperative(49±7.6)points to postoperative(89.6±8.5)points,with statistically significant difference(t=9.97,P<0.01).Among all the patients,3 patients had infections around the pin tract and were cured after conservative treatment;1 case of screw fracture occurred and was removed through surgery;3 patients were unstable after removal of the external fixator and the stability of the elbow joint was restored after more than 12 months of follow-up.At the last follow-up of all the patients,1 patient had heterotopic ossification of the elbow joint;there were 4 cases of ulnar nerve symptoms and4 cases of moderate pain in the elbow joint.The functional decline of wrist joint in all the patients was improved at the last follow-up,and the excellent and good rate of Mayo wrist performance score was 100%.None of the patients had fractures around the pin tract.Conclusion and significanceWith postoperative targeted rehabilitation,application of open arthrolysis combined with improved hinged external fixator proves its safety,low complication rate and significant effect in the treatment of elbow stiffness,which is worthy of clinical application.Part 2:OBSERVATION OF THE CURATIVE EFFECT OF SYSTEMATIC REHABILITATION EXERCISE AFTER THE ARTHROLYSIS OF ELBOW STIFFNESSObjectiveThe elbow joint fracture is easy to cause dysfunction.Currently,the surgical treatment of elbow joint stiffness is relatively mature,but the postoperative rehabilitation exercise is lack of effective guidance.This study is to investigate the effect of different rehabilitation models after the arthrolysis of the elbow joint,and to propose a rehabilitation model suitable for the arthrolysis of the elbow joint.MethodsAltogether 40 cases of patients who underwent open arthrolysis of the elbow joint from October 2015 to February 2016 in our hospital were collected and involved as Experiment Group;another 40 cases who accepted outpatient reexaminations after open arthrolysis of the elbow joint were randomly selected and involved as Control Group.The traditional postoperative orthopedics rehabilitation model was adopted in Control Group;while,the integrated orthopedics rehabilitation model was used in Experiment Group,which meant the rehabilitation guidance group consisted of orthopedics physicians,rehabilitation physicians and nurses explained and publicized the key point and the importance of rehabilitation exercise,jointly formulated rehabilitation program and guided rehabilitation exercise for patients.The elbow joint activity and the Mayo elbow performance score(MEPS)were recorded at both the preoperative and postoperative follow-up.Visual analogue scores(VAS)were performed at 5 days,10 days and 6 weeks postoperatively,12 weeks and 24 weeks after surgery for patients with Hospital for special surgery 2(HSS2)elbow subjective score assessment.ResultsAt the last follow-up,the functions of both the two groups were satisfied.There was no significant difference between the two groups in the average activity of the elbow joint and the excellent and good rate of MEPS(P>0.05),but there was significant difference in the mean score of MEPS(P=0.01).The VAS score of Experiment Group at postoperative 5days,10 days and 6 weeks was(4.93±2.14)points,(2.75±1.12)points and(1.10±1.64)points versus Control Group's(4.31±1.65)points,(2.38±0.76)points and(1.16±1.42) points,with no significant difference between two groups(P>0.05).Subjective evaluation of HSS2: The subjective score of Experiment Group at postoperative 12 weeks was(76.45±16.05)versus Control Group's(69.41±18.53),without statistically significant difference(P>0.05);the subjective score of Experiment Group at postoperative 24 weeks was(89.74±8.90),better than that of Control Group [(81.57±20.07)](P=0.021).According to the results of the quadruple tabular form chi square test in the recovery time,?2=5.079,P=0.024,with statistically significant difference.Conclusion and significanceIntegrated orthopedics rehabilitation mode after arthrolysis of elbow joint can better improve the patients' post-arthrolysis function indexes without increase of the rehabilitation pain,which can be used as early rehabilitation mode after arthrolysis of elbow joint. |
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