Clinics in Shoulder and Elbow

Korean Shoulder and Elbow Society (대한견·주관절의학회)
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Debridement Arthroplasty using Posteromedial Approach in Elbow Joint with Pain and Bony Limitation of Motion

동통과 골성 운동 제한이 있는 주관절에서 후내측 도달법을 이용한 변연 절제 관절 성형술

  • Cheon, Sang-Jin (Department of Orthopedic Surgery, College of Medicine, Pusan National University) ;
  • Lee, Dong-Ho (Department of Orthopedic Surgery, College of Medicine, Pusan National University) ;
  • Cha, Seung-Han (Department of Orthopedic Surgery, College of Medicine, Pusan National University) ;
  • Kim, Hui-Taek (Department of Orthopedic Surgery, College of Medicine, Pusan National University) ;
  • Suh, Jeung-Tak (Department of Orthopedic Surgery, College of Medicine, Pusan National University)
  • 천상진 (부산대학교 의과대학 정형외과학교실) ;
  • 이동호 (부산대학교 의과대학 정형외과학교실) ;
  • 차승한 (부산대학교 의과대학 정형외과학교실) ;
  • 김휘택 (부산대학교 의과대학 정형외과학교실) ;
  • 서정탁 (부산대학교 의과대학 정형외과학교실)
  • Published : 2009.06.15
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Abstract

Purpose: This study evaluated the clinical outcomes of debridement arthroplasty using the posteromedial approach in elbow joints with pain and bony limitation of motion. Materials and Methods: This study involved 16 elbows in 16 patients with pain and bony limitation of motion, which were treated by debridement arthroplasty using the posteromedial approach from March 2005 to March 2008. The mean follow up period was 27.6 (13~52) months. The clinical outcomes were analyzed using the Visual Analogue Scale(VAS) for pain scale, the preoperative and postoperative range of motion and the Mayo Elbow Performance Scores(MEPS). Results: The VAS was decreased significantly from a preoperative mean of 4.5 to a postoperative mean 1.1 (p<0.001). The average arc of motion improved significantly from $61.6 (0~90)^{\circ}$ preoperatively to $109.4 (80-120)^{\circ}$ postoperatively (p<0.001). The MEPS also improved significantly from 59.4 to 85.6 postoperatively (p<0.001). There were no complications, such as hematoma and elbow instability. Conclusion: Debridement arthroplasty using the posteromedial approach is a useful surgical procedure in the elbow joint with pain and bony limitation of motion, where all compartments can be debrided, the ulnar nerve can be manipulated easily and damage to the medial collateral ligament can be minimized.

목적: 동통과 골성 운동 제한이 동반된 주관절에 대해 후내측 도달법을 이용한 변연 절제 관절 성형술의 임상적 결과를 분석하였다. 대상 및 방법: 2005년 3월부터 2008년 3월까지 주관절의 동통과 골성 운동 제한으로 후내측 도달법을 통한 변연 절제 관절 성형술을 시행 받은 16명을 대상으로 하였다. 추시 관찰 기간은 평균 27.6(13~52)개월이였다. 통증에 대해서 Visual Analogue Scale, 술 전과 술 후 굴곡, 신전, 운동범위를 측정하고 기능에 대해서 Mayo Elbow Performance Score (MEPS)를 측정하여 분석, 평가 하였다. 결과: 최종 추시 시 VAS (visual analogue scale )는 술 전 평균 4.5에서 술 후 평균 1.1으로 통계학적으로 유의한 감소(p<0.001 )를 보였다. 관절 운동 범위는 술 전 평균 $61.6^{\circ}$(0~90)에서 술 후 $109.4^{\circ}$(80~120)로 통계학적으로 유의하게 증가하였다(p<0.001). MEPS 역시 술 전 59.4에서 술 후에는 85.6으로 증가하였다(p<0.001). 술 후 혈종이나 주관절 불안정증 같은 합병증은 없었다. 결론: 후내측 도달법을 이용한 변연 절제 관절 성형술은 쉽게 척골 신경에 대한 조작이 가능하고 주관절 내측 측부 인대의 손상을 최소화 할 수 있으며 주관절 전 구획(all compartment)에 광범위한 변연 절제가 가능하여 동통과 골성 관절 운동 제한이 동반된 주관절에서 동통의 감소와 관절 운동 범위의 회복에 도움이 되는 유용한 술식으로 사료된다.

Keywords

References

  1. Baek GH, Kwon BC, Chung MS: Comparative study between minimal epicondylectomy and anterior subcutaneous transposition of the ulnar nerve for cubital tunnel syndrome. J Shoulder Elbow Surg, 15: 609-615, 2006. https://doi.org/10.1016/j.jse.2005.10.007
  2. Cage DJ, Abrams RA, Callahan JJ, Botte MJ: Soft tissue attachments of the ulnar coronid process. An anatomic study with radiographic correlation. Clin Orthop Relat Res, 320: 154-158, 1995.
  3. Deland JT, Walker PS, Sledge CB , Farberov A: Treatment of posttraumatic elbows with a new hingedistractor. Orthopaedics, 6: 732-737, 1983.
  4. Green DP, McCoy H: Turnbuckle orthotic correction of elbow flexion contracture after acute injuries. J Bone Joint Surg Am, 61: 1092-1095, 1979.
  5. Hepburn GR, Crivelli KJ: Use of elbow Dyynasplint for reduction of elbow flexion contractures: a case study. J Orthop Sports Phys Ther, 5: 269-274, 1984. https://doi.org/10.2519/jospt.1984.5.5.269
  6. Huskisson EC, Dieppe PA, Tucker AK, Cannell LB: Another look at osteoarthritis. Ann. Rheum Dis, 38:423-428, 1979. https://doi.org/10.1136/ard.38.5.423
  7. Kleinman WB: Cubital tunnel syndrome: anterior transposition as a logical approach to complete nerve decompression. J Hand Surg Am, 24: 866-897, 1999. https://doi.org/10.1053/jhsu.1999.0866
  8. Leffert RD.: Anterior submuscular transposition of the ulnar nerves by the Learmonth technique. J Hand Surg, 7:147-155, 1982. https://doi.org/10.1016/S0363-5023(82)80079-8
  9. Minami M, Ishii S: Outerbridge-Kashiwagi arthroplasty for osteoarthritis of the elbow joint. In: Kashiwagi D ed. Elbow joint. Amsterdam, Elsevier Science Pubilshers BV:189-196, 1985.
  10. Morrey BF, Askew LJ, An KM: A biomechanical study of normal functional elbow motion. J Bone Joint Surg Am, 63: 872-877, 1981.
  11. Morrey BF, AN KN: Articular and ligamentous contributions to the stability of the elbow joint. Am J Sports Med. 11: 315-318, 1983. https://doi.org/10.1177/036354658301100506
  12. Morrey BF: Post-traumatic stiffness: Distraction arthroplasty. In: Morrey BF ed. The elbow and its disorders. 1st ed. Philadelphia, WB Saunders Co: 476-491, 1985.
  13. Morrey BF: Primary degenerative arthritis of the elbow. J Bone Joint Surg Br, 74: 409-413, 1992.
  14. O'Driscall SW: Arthroscopic treatment for osteoarthritis of elbow. Orthop Clin North Am, 26: 691-706, 1995.
  15. Ogilvie-Harris DJ, Gordon R, Mackay M: Arthroscopic treatment for posterior impingement in degenerative arthritis of the elbow. Arthroscopy, 11: 437-443, 1995. https://doi.org/10.1016/0749-8063(95)90198-1
  16. OKa Y, Ohta K, Saitoh I: Debridement Arthroplasty for Osteoarthritis of the Elbow. Clin Orthop Relat Res, 351: 127-134, 1998.
  17. Oka Y: Debridement arthroplasty for osteoarthrosis of the elbow. Acta Orthop Scand, 71: 185-190, 2000. https://doi.org/10.1080/000164700317413175
  18. Rhee KJ, Shin HD, Kim KC, Hong CH, Song HS:Arthroscopic treatment of stiff elbow. J Korean Shoulder Elbow Soc, 8: 14-18, 2005. https://doi.org/10.5397/CiSE.2005.8.1.014
  19. Rhee YG, Kim HS, Chun YS, Cho YL: Debridement Arthroplasty for Post-Traumatic Stiff Elbow. J Korean Shoulder Elbow Soc, 1: 242-249, 1998.
  20. Rhyou IH, Chung CI, Suh BG, Kim KC: Surgical treatment of the primary osteoarthritis of the elbow joint by modified outerbridge-kashiwagi procedure. J Korean Soc Surg Hand, 12: 162-169, 2007.
  21. Samuel AA, Morrey BF, Adams RA, O'Driscoll SW:Ulnohumeral arthroplasty for primary degenerative arthritis of the elbow. J Bone Joint Surg Am, 84: 2168-2173, 2002.
  22. Tsuge K, Mizuseki T: Debridement arthroplasty for advanced primary osteoarthritis of the elbow. J Bone Joint Surg Br, 76: 641-646, 1994.
  23. Urbaniak JR, Hansen PE, Beissinger SF, Aitken MS: Correction of post-traumatic flexion contracture of the elbow by anterior capsulotomy. J Bone Joint Surg Am, 67: 1160-1164, 1985.
  24. Wada T, Isogal S, Ishii S, Yamashita T: Debridement arthroplasty for primary osteoarthrit-is. J Bone Joint Surg Am, 86: 233-241, 2004.
  25. Wright PE, Froimson AK, Stewart MJ: Interpositional arthroplasty of the elbow. The Elbow and Its Disorders. 2nd ed. Philadelpha WB Saunders Co : 611-622, 1993.
  26. Pyun YS, Jeon SH, Bae KC, Yeo KK: Anterial subcutaneous ulnar nerve transposition for cubital tunnel syndrome. J Korean Shoulder Elbow Soc, 8: 36-42, 2005. https://doi.org/10.5397/CiSE.2005.8.1.036

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