Clinics in Shoulder and Elbow

Korean Shoulder and Elbow Society (대한견·주관절의학회)
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The Open Surgical Treatment for Stiff Elbow

주관절 구축의 관혈적 치료

  • Lee, Ji-Ho (Department of Orthopedic Surgery, College of Medicine, Kyungpook National University) ;
  • Ra, In-Hoo (Department of Orthopedic Surgery, College of Medicine, Kyungpook National University) ;
  • Jeon, In-Ho (Department of Orthopedic Surgery, Asan Medical Center, College of Medicine, Ulsan University)
  • 이지호 (경북대학교 의과대학 정형외과학교실) ;
  • 라인후 (경북대학교 의과대학 정형외과학교실) ;
  • 전인호 (울산대학교 의과대학 서울아산병원 정형외과학교실)
  • Received : 2010.12.07
  • Accepted : 2010.12.07
  • Published : 2010.12.15
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Abstract

Purpose: Since an injured elbow joint can disturb the activity of daily life by limiting motion, especially if the motion is restricted over 40 degree of flexion contracture and under 105 degree of further flexion, it is imperative to select the best method and the timing of treatment of the elbow stiffness. Therefore this review will discuss open surgical techniques for stiff elbows based on the literature. Materials and Methods: It is important to take sufficient clinical examination of the patient, including history taking. And, a surgeon should select appropriate procedure after accurately understanding about the status and cause of the stiff elbow with radiographic methods. Surgical methods include arthroscopic release open release, distraction arthroplasty, total elbow replacement and there are four approachs in the open release - anterior approach, medial "over the top" approach, limited lateral approach: column procedure, posterior extensile approach-. Results and Conclusion: Although at present the arthroscopic technique is emphasized for the treatment of elbow stiffness, a surgeon should know conventional open techniques.

목적: 주관절은 굴곡 구축 40도 이상 굴곡 제한 105도 이하일 경우 일상 생활에 상당한 장애를 일으킬 수 있는 관절로 그 치료의 정도 및 시기를 결정하기가 상당히 어려운 것으로 알려져 있다. 이에 이 종설에서는 현재까지 인정된 주관절 구축의 수술적 접근법에 대하여 고찰하여 보도록 하겠다. 대상 및 방법: 환자의 병력을 포함하여 충분한 임상적 조사를 하는 것이 중요하다. 그리고 방사선학적 방법을 이용하여 환자의 주관절 구축에 대한 원인 및 상태를 정확히 파악하고 그에 적합한 수술법을 선택한다. 수술법으로는 관절경적 유리술 (arthroscopic release) 및 관혈적 유리술 (Open release), 견인 관절 성형술 (Distraction Arthroplasty), 인공관절 치환술 (Total elbow replacement)이 있으며 관혈적 유리술은 4가지 기본 도달법 -전방 도달법 (anterior approach), 내측 도달법 (medial "over the top" approach), 제한된 외측 도달법 (limited lateral approach: column procedure) 광범위 후방 도달법 (posterior extensile approach)-으로 분류될 수 있다. 결과 및 결론: 현재 주관절 구축의 수술은 관절경의 발달로 인한 최소 침습적인 방법이 대두되고 있으나 그 경과의 판정은 아직 미미하며 그에 대한 문헌 보고가 많지 않은 상태로 고식적인 개방성 접근법을 이용하는 것을 원칙으로 하고 있으며 접근법에 따른 분류를 사용하고 있다.

Keywords

References

  1. Aldridge JM 3rd, Atkins TA, Gunneson EE, Urbaniak JR: Anterior release of the elbow for extension loss. J Bone Joint Surg Am, 86: 1955-1960, 2004.
  2. An KN, Morrey BF, Chao EY: The effect of partial removal of proximal ulna on elbow constraint. Clin Orthop Relat Res, 209: 270-279, 1986.
  3. Ball CM, Meunier M, Galatz LM, Calfee R, Yamaguchi K: Arthroscopic treatment of post-traumatic elbow contracture. J Shoulder Elbow Surg, 11: 624-629, 2002. https://doi.org/10.1067/mse.2002.126770
  4. Deland JT, Garg A, Walker PS: Biomechanical basis for elbow hinge-distractor design. Clin Orthop Relat Res, 215: 303-312, 1987.
  5. Figgie MP, Inglis AE, Mow CS, Figgie HE 3rd: Total elbow arthroplasty for complete ankylosis of the elbow. J Bone Joint Surg Am, 71: 513-520, 1989.
  6. Gates HS 3rd, Sullivan FL, Urbaniak JR: Anterior capsulotomy and continuous passive motion in the treatment of post-traumatic flexion contracture of the elbow. A prospective study. J Bone Joint Surg Am, 74: 1229-1234, 1992.
  7. Jupiter JB, O'Driscoll SW, Cohen MS: The assessment and management of the stiff elbow. Instr Course Lect, 52: 93-111, 2003.
  8. Mansat P, Morrey BF: The column procedure: a limited lateral approach for extrinsic contracture of the elbow. J Bone Joint Surg Am, 80: 1603-1615, 1998.
  9. Marti RK, Kerkhoffs GM, Maas M, Blankevoort L: Progressive surgical release of a posttraumatic stiff elbow. Technique and outcome after 2-18 years in 46 patients. Acta Orthop Scand, 73: 144-150, 2002. https://doi.org/10.1080/000164702753671713
  10. Mohan K: Myositis ossificans traumatica of the elbow. Int Surg, 57: 475-478, 1972
  11. Morrey BF: Post-traumatic contracture of the elbow. Operative treatment, including distraction arthroplasty. J Bone Joint Surg Am, 72: 601-618, 1990.
  12. Morrey BF: Posttraumatic stiffness: distraction arthroplasty. Orthopedics, 15: 863-869, 1992.
  13. Nicholson GP. Arthroscopic capsular release for stiff shoulders: effect of etiology on outcomes. Arthroscopy, 19: 40-49, 2003.
  14. Regan WD, Reilly CD: Distraction arthroplasty of the elbow. Hand Clin, 9: 719-728, 1993.
  15. Sojbjerg JO, Ovesen J, Gundorf CE: The stability of the elbow following excision of the radial head and transection of the annular ligament. An experimental study. Arch Orthop Trauma Surg, 106: 248-250, 1987. https://doi.org/10.1007/BF00450463
  16. Sojbjerg JO, Ovesen J, Nielsen S: Experimental elbow instability after transection of the medial collateral ligament. Clin Orthop Relat Res, 218: 186-190, 1987.
  17. Vardakas DG, Varitimidis SE, Goebel F, Vogt MT, Sotereanos DG: Evaluating and treating the stiff elbow. Hand Clin, 18: 77-85, 2002. https://doi.org/10.1016/S0749-0712(02)00005-7
  18. Wada T, Ishii S, Usui M, Miyano S: The medial approach for operative release of post-traumatic contracture of the joint. J Bone Joint Surg Br, 82: 68-73, 2000. https://doi.org/10.1302/0301-620X.82B1.9782