| Clinically,elbow dysfunction is quite common.It is mainly caused by inside and outside of the joint factors.Trauma,bone disease,surgery,long-term braking or other adverse incentives may lead to it.Since the anatomic structure of elbow joint is complex.In the past,the diagnosis and treatment of elbow disease may be conservative rehabilitation,traditional Chinese medicine or open surgical treatment.However,the emergence and development of minimally invasive arthroscopic technology for the diagnosis and treatment of elbow disease has opened up an important way,and it has a broad application prospects,is the focus of research institutions at home and abroad.But with the elbow arthroscopy in the clinical application of the instructions gradually widened,the surgical complications,the specific details of the operation,as well as postoperative rehabili tation exercises and other aspects of the problem has gradually highlighted,the academic community of this study reported that the views are not Consistent with the clinical efficacy of the differences are greater,more controversial.Compared with the number of other joints,such as hip,knee,shoulder,ankle and so on,the number of elbow cases is relatively less than others,so that the learning curve is steep.So the literature and academic exchanges are relatively few.Our centre started elbow arthroscopy since 2003,the numbers of elbow arthroscopy increased year by year,the accumulation of more cases of surgical data,clinical treatment technology constantly improved,in order to better sum up experience,to further improve the level of surgical technology and Treatment in this article from January 2009 to December 2015 during the Department of arthroscopic surgery in the treatment of elbow joint dysfunction in the majority of mainstream disease were retrospectively analyzed,technical discussion,and discuss out our innovative technology.Because the elbow has two degrees of freedom in the direction,so the dysfunction is mainly manifestations of flexion and extension dysfunction and / or rotation dysfunction,and two types of surgical techniques and postoperative rehabilitation are different,so we have classified the cases according to this classification.There are a few cases of flexion and extension dysfunction combined with rotation dysfunction,but the number of cases is few,and the treatment strategy can be combined with the combination of the two,so the impact of our study can be ignored.However,in the analysis of the study we found that elbow joint dysfunction in patients with many cases are caused by elbow synovitis and they had largh number of cases.because of its deferent pathophysiology,surgery and postoperative treatment.So,The data of this study were subdivided into(1)elbow flexion and extension dysfunction;(2)elbow joint rotation dysfunction;(3)elbow joint dysfunction ca used by total elbow synovitis.The clinical efficacy and safety of minimally invasive treatment of elbow arthroscopy for elbow joint dysfunction were discussed in the above three cases.Part ?: An analysis of arthroscopic surgery for elbow flexion and extension dysfunctionObjective: To explore the clinical efficacy of arthroscopy in the treatment of elbow flexion and extension dysfunction.Methods: A total of 154 patients(158 elbows)with elbow flexion and extension dysfunction were treated in center of joint surgery in the First Affiliated Hospital of the Army Medical University from January 2009 to December 2015.Of these,90(94 elbows)were elbow extention overlaod syndrome,64 cases were elbow joint traumatic arthritis dysfunction.All patients underwent arthroscopic the removal of the free radicals,resection of the anterior joint capsule,the coronoid process+fossae coronoidea plasty,the olecranon+fossae olecrani plasty,and supplemented with appropriate manipulation.And all patients were given anti-inflammatory drugs and symptomatic treatment,and were guided to undergo a rigorous rehabilitation training.All patients were followed up to evaluate the therapeutic effect of elbow joint dysfunction before and after surgery:(1)All patients were examined bypreoperative X-ray examination,1 month,3 months and 12 months after operation,and recorded their entention agle,flexion angle and ROM.(2)Tthe use of Mayo elbow score and improved HSS elbow score system for preoperative and postoperative 1 month,3 months,12 months elbow joint function recovery;(3)Applying the Visual Analogue Scale / Score(VAS)to assess the pain of the elbow joint at 1 month,3 months and 12 months before and after surgery.Results: 144 patients(148 elbows)were followed up for 9-28 months(mean 18.9 months).Ten patients were lost.No infection,vascular injury,joint instability,Ossification Myositis and other complications.Postoperative swelling and pain symptoms effectively alleviate,flexion and extension activities improved significantly,of which 1 case of patients with a transient tourniquet paralysis symptoms,disappeared after 3 days,1 case happened to postoperative ulcer neuritis symptoms,treated with hormones treatment,nutrition nerves and other positive symptomatic treatment,4 months after the surgery the ulnar nerve symptoms disappeared;1 case of 6 weeks after surgery compared to 2 weeks after surgery,the elbow joint function decreased,then were treated with Manipulation of the release under anesthesia,and to give strict rehabilitation exercise supervision and supervision,after 3 months of joint mobility was significantly improved.The elbow flexion activity,flexion activity,total ROM,and elbow joint mobility index and Mayo elbow scroe and improved HSS elbow score were performed in the patients before and 1 month,3 months and 12 months after operation(P <0.05).The results of F test showed that the flexion and extension activities of the elbow and the rotational activity were compared with those before operation,1 month,3 months and 12 months after operation.(P <0.05),and there was significant difference between Mayo and modified HSS elbow joint function scores(P <0.05).In addition,the postoperative pronation angle,posterior rotation angle and rotation range of patients with elbow joint rotation dysfunction were significantly improved compared with those before operation,the difference was statistically significant(P <0.05).Compared with preoperative,the pain of the elbow was significantly relieved,and the VAS score of the elbow was significantly decreased at 1 month,3 months and 12 months after operation,which was significantly different from that before operation(P <0.05).Conclusion: Elbow arthroplasty was used to treat elbow flexion and extension dysfunction.According to our theoretical model,the corresponding analysis was carried out.Then,under the condition of good analgesia,combined with scientific and reasonable rehabilitation training,it showed significant effect,less surgical damage,less bleeding,fewer patients with postoperative complications,small pain and rapid recovery,is the treatment of the disease effective and safe surgical approach.However,due to the professional knowledge of elbow arthroscopic surgery,technical and clinical experience are very high requirements,the surgeon in particular need to have skilled arthroscopic techniques and rich anatomical knowledge to master all kinds of lesions in the case of the front joints The core of the cystectomy.This is the first time we describe in detail the theoretical model of flexion and extension of the elbow joint and the core technique of the external joint capsule amputation,in order to achieve the anterior and posterior elbow joint release.Maximize the patient's elbow function.Part ?: arthroscopic treatment of elbow joint rotation dysfunction analysis.Objective: To explore the clinical efficacy of arthroscopy in the treatment of elbow joint rotation dysfunction.Methods: 26 patients with rotational disorders of the elbow joint were treated with traumatic joint surgery in our center of the First Affiliated Hospital of the Army Medical University from January 2009 to December 2015.Among them,18 patients were radial head fractures of the elbow joint and 6patients were the radial head fracture with operative treatment,and 2 patients were humeral head exfoliative osteochondritis.All patients underwent arthroscopic treatment,the surgical types were selected according to the different preoperative diagnosis: arthroscopic ring ligament clearance and releas e surgery,arthroscopic reduction of radial head internal fixation,arthroscopic radial head resection,and auxiliary with appropriate means to release,after surgery to strengthen anti-inflammatory analgesic swelling and symptomatic treatment,and to guid e patients to undergo a rigorous rehabilitation training.All patients were followed up to evaluate the efficacy of elbow joint dysfunction before and after surgery:(1)All patients were routinely examined by X-ray before operation,1 month,3 months and 12 months,and recorded their entention agle,flexion angle and ROM;(2)the use of Mayo elbow score and improved HSS elbow score system for preoperative and postoperative 1 month,3 months,12 months elbow joint function recovery;(3)The VAS visual analogue scale was used to evaluate the pain of elbow joint before and 1 month,3 months and 12 months after operation.Results: 26 patients in this group were followed up for 9-26 months,an average of 15.8 months.The total surgery time were 51-95 minutes,with average of 62.5 minutes.No postoperative infection,vascular or nerve injury,joint instability,ossifying myositis and other complications.The rotation function of the elbow joint was significantly restored,pronation angle was significantly increased;12 months after surgery according to improved HSS elbow score,excellent in 22 cases,good in 4 cases.The degree of flexion,flexion activity,total flexion and extension range,pronation angle,rotation angle,ROM,etc.of the elbow in the four months before and 1 month,3 months and 12 months after operation Elbow joint activity index and Mayo elbow function score,improved HSS elbow joint function score were compared to ? = 0.05 for the standard,F test results show: compared with preoperative,postoperative 1 month,3 months and 12 months of elbow flexion and extension activity and rotational activity and other indicators were significantly improved,Mayo and improved HSS elbow joint function score was significantly improved,while patients with postoperative elbow pain was significantly relieved,and postoperative VAS score was significantly reduced compared with preoperative VAS scores(P <0.05).Part ?: An analysis of arthroscopic surgery for elbow joint dysfunction caused by total elbow synovitisObjective: To explore the clinical efficacy of arthroscopy in the treatment of total elbow synovitis with dysfunction.Methods: From January 2009 to December 2015,53 patients(54 elbows)with elbow joint synovitis and elbow dysfunction were treated in our center for joint surgery in the First Affiliated Hospital of the Army Medical University.All patients were diagnosed with elbow synovitis by serological examination,synovial fluid examination and imaging examination.All of them showed varying degrees of elbow joint pain,joint interlocking and flexion and extension function,including total elbow tuberculosis in 24 Cases,rheumatoid arthritis in 13 cases(14 elbows),synovial chondromatosis in 10 cases,pigmented villonodular synovitis(PVNS)in 3 cases,3 cases of gouty arthritis.All patients underwent arthroscopic total synovial resection,supplemented by appropriate manipulation of the release,after surgery to strengthen anti-inflammatory analgesic swelling and symptomatic treatment,and to guide patients to undergo a rigorous rehabilitation training.Continue medical treatment for the cause.All patients were followed up to evaluate the efficacy of elbow join t dysfunction before and after surgery:(1)All patients were routinely examined by X-ray before operation,1 month,3 months and 12 months after the surgery,and recorded their entention agle,flexion angle and ROM;(2)the use of Mayo elbow score and improved HSS elbow score system before surgery and 1 month,3 months,12 months after surgery(3)The VAS visual analogue scale was used to evaluate the pain of elbow joint before surgery,and 1 month,3 months and 12 months after operation.Results: 53 patients(54 elbows)were followed up for 9-23 months(mean,16.4 months).Postoperative pathological examination,synovial fluid and synovial tissue of the laboratory test results and preoperative diagnosis are in full compliance.No infection,vascular or nerve injury and other complications.9 cases of tuberculosis with sinus in patients with 8 cases of sinus completely closed,1 case of delayed healing(the patient had a history of surgery),2 weeks after surgery in the stitches still effusi ng,continue to give anti-tuberculosis(additional streptomycin + levofloxacin),local dressing and intra-articular injection of anti-TB drugs,1 week later the sinus were completely closed,swelling and pain disappeared.All 24 patients with tuberculous synovitis in the elbow joint surgery within 1.5-2 years after the withdrawal of anti-TB drugs,to follow-up end of the period without recurrence.All patients with elbow swelling and pain were significantly reduced,elbow joint symptoms all disappeared.Postoperative elbow flexion and extension function was significantly improved;12 months after surgery according to improved HSS elbow score,excellent in 48 cases,good in 4 cases,1 case.The elbow flexion,flexion activity,total ROM,and the elbow joint function score of the elbow joint were measured before and 1 month,3 months and 6 months after operation.The results of F test showed that the flexion activity,flexion activity,total flexion and extension activity of elbow joint were compared with those before operation,1 month,3 months and 12 months after operation.(P <0.05).The scores of elbow flexion were significantly improved,the pain of elbow joint was significantly improved in Mayo and improved HSS scores,and the VAS score was significantly decreased and the difference was statistically significant(P <0.05).Conclusion: The effect of synovial resection of synovial resection of the elbow joint is good,the elbow joint disease exploration and clean-up is complete.Using the six-channel approach described in this paper,to ensure complete removal of synovial tissue synovial tissue,High safety,greatly improve the efficiency of treatment,patients with rapid postoperative recovery.arthroscopic surgery may be called the gold standard of the elbow joint synovitis surgery.But the preoperative diagnose is rather important,throughout the perioperative adherence to adequate course of treatment,accurate medical treatment to ensure the overall efficacy of treatment. |
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