| Research background:Elbow joint stiffness is one of the common postoperative complications after fractures around the elbow joint.Due to the anatomical structure of the elbow joint,the elbow joint is prone to heterotopic ossification after trauma,resulting in elbow joint stiffness which may eventually affect the patient's daily life.There are many solutions to solve this problem such as arthroscopic release,elbow arthrolysis,elbow arthrolysis + hinged external fixator,and elbow replacement,however,it has always been a challenge on how to choose an effective surgical method in clinical work.There is not only challenge in regards to the in view of the functional requirements of the elbow joint,but also the recurrence risk of heterotopic ossification.Objective:In order to compare the effect in between elbow arthrodesis(including release after removal of the internal fixation)with elbow arthrolysis and hinged external fixation of the elbow joint stiffness caused by heterotopic ossification,we conducted a retrospective study of 30 patients with elbow stiffness to provide references and justifications for the treatment of elbow stiffness caused by heterotopic ossification.Materials and Methods:In this study,we analyzed 41 cases of patients with elbow stiffness caused by heterotopic ossification admitted in the department of orthopedics from February 2015 to July 2019 of China-Japan Union hospital of Jilin University,and 30 out of the 41 who were fit for the criteria would be selected for further study.In the treatment group,16 patients were treated with elbow arthrodesis(including release after removal of internal fixation),while the other 14 patients were treated with elbow arthrodesis + hinge external fixation(including release after removal of internal fixation).There were 4 comminuted proximal and radial fractures,8 small radial head fractures,10 olecranon fractures,2 ulnar coronoid fractures,4 distal humerus fractures,and 2 old elbow dislocation.All 30 patients remained stable after the operation,with a median follow-up of 3.1 months(1-4 months)and a final mean follow-up of 24.3 months(ranging from 6 to 49 months).SPSS21.00 was used as the statistical analysis method.Preoperative and postoperative Mayo score,preoperative and postoperative elbow joint motion,operation time,and operative blood loss were compared between the two groups.P <0.05 was considered statistically significant.Results:We found that both surgical regimens achieved the same Mayo score(p=0.276)in the improvement in elbow stiffness in the final follow-up with no statistical differences.However,in the mid-term follow-up,there was a significant statistical difference in between the two surgical options(P=0.006),in which the Mayo score of elbow arthrodesis + hinged external fixation stent was 91.43±7.187,while the Mayo score of elbow arthrodesis alone was 81.25±7.638.Similarly,there was no statistical difference in between both surgical regiments in improving the range of motion of the elbow(P=0.161),but there was a significant difference in the range of motion of the elbow during the mid-term follow-up(P=0.001).The range of motion of the elbow joint were 112.14±11.044°in the elbow arthrodesis + hinged external fixation group,and 99.06±8.410°in the elbow arthrodesis group.In terms of surgical indicators,there was no statistical difference in the amount of blood loss between the two surgical methods(P=0.728),while there was a statistical difference in the operation time(P=0.002).Conclusion:The elbow arthrodesis and the elbow arthrodesis + hinged external fixation are important surgical method for the treatment of elbow stiffness caused by heterotopic ossification of the elbow joint.From the perspective of surgical stroke,the blood loss of the two is similar,but the operation time of elbow arthrodesis + hinge external fixation stenting is longer,with an average of 102.14±10.76,which is higher than that of elbow arthrodesis(90.63±7.289).In the long term,there was no significant statistical difference in the improvement of elbow joint function between the two groups,but arthrodesis + hinged external fixation achieved better results in restoring elbow joint motion and improving elbow joint function in the medium term. |
PDF Full Text Request