Elbow Arthrodesis

After the elbow joint is fixed, it has a great influence on work and life. Only when there is too much scar in the joint disease and surrounding soft tissue, it is not appropriate to use other methods to treat the elbow joint fusion. Treatment of diseases: elbow joint tuberculosis traumatic elbow arthritis Indication After the elbow joint is fixed, it has a great influence on work and life. Only when there is too much scar in the joint disease and surrounding soft tissue, it is not appropriate to use other methods to treat the elbow joint fusion. Contraindications In addition to the general contraindications for elective surgery, the following conditions should also be contraindicated: 1. Patients with osteoarthritis adjacent to the joint should not be used for arthrodesis. If the hip joint is fused, its activity can be compensated by the normal lumbar spine and knee joint to meet the needs of work and life activities. If the lower lumbar or knee joint is already stiff, hip fusion will cause great difficulty to the patient. 2. Among the same joints of the limbs, one side has a strong straight, and the contralateral side should not be subjected to arthrodesis. If the hip joints are fused on both sides, it will be very difficult to get up, lie, walk and sit. 3. Children's articular cartilage is rich, joint fusion is not easy to cause bone fusion, but also easy to damage the epiphysis, affecting growth and development; at the same time, children in the limb development stage and muscle sustained action, the fusion joint can be deformed again. Therefore, children under the age of 12 should not undergo arthrodesis. Preoperative preparation 1. Arthrodesis may actually include a series of operations such as lesion removal, joint fusion, bone transplantation, and correction of deformity, so it is a complicated operation. Therefore, the surgical plan should be determined according to these surgical requirements, comprehensive consideration, try to get a surgery, a cut to solve the problem, in order to achieve the best results at the least cost. 2. Loss of activity after joint fusion can cause the patient's ideological concerns, and should be dispelled before surgery: the fusion of a joint that affects the function of the limb will improve the function of the entire limb. 3. The joints of the shoulders, hips and other large joints have more bleeding during the operation, and there is a possibility of shock. A certain amount of blood should be reserved before surgery. When the elbow and knee joints are operated, the inflatable tourniquet is used to keep the field clear for the operation. 4. Inflammatory joint disease (such as tuberculosis, suppurative) should be applied preoperative antibiotics or anti-tuberculosis drugs to control the infection or prevent the recurrence of the resting lesion. 5. If the joint has soft tissue contracture, the deformity will not be easily corrected during the operation, and the joint will be difficult to reset. It is difficult to maintain stability even if it is barely repositioned; if it is strongly corrected during surgery, it will cause damage to nerves, blood vessels, etc. Postoperative muscle spasm, and even cause complications such as dislocation. Therefore, traction should be performed before surgery to overcome contracture as much as possible; and design the steps to relieve contracture during surgery. Surgical procedure 1. Position: supine position, the elbow is placed on the chest. If the elbow is stiff and straight, the side of the sick side will be slightly raised. The lateral position can also be used, the diseased side is on the upper limb, and the upper limb is extended forward and placed on the side small operation table. 2. Incision, exposure: The upper arm is placed with an inflatable tourniquet. Make a longitudinal incision on the posterior side of the elbow (see the posterior side of the elbow joint). After the incision, the ulnar nerve is first separated (if the scar is more adherent, it should be found in the proximal normal tissue, and then separated downward), and the rubber strip is used to open the protection. For those who have contractures on the triceps, the aponeurosis should be cut into the tongue for extension. Close to the subperiosteal stripping of the cortical bone, revealing the lower end of the humerus, the olecranon and the humeral head. When peeling off the front side of the elbow joint, care should be taken to avoid damage to the anterior blood vessels and nerves, and to fill the gauze isolation protection before continuing the intra-articular operation. There are adhesions in the joints, which can be separated by a bone knife. For patients with osteoarthritis of the joints, use a bone chisel to open, do not use violent flexion to avoid fracture of the bone, resulting in difficult surgery. After the joint is separated, the elbow can be bent to reveal the joint component bone. 3. Excision of the cartilage surface and the humeral head: If there is a lesion in the joint cavity, it should be removed first, then the cartilage surface of the tibial block and the olecranon should be removed (and then the humeral head should be removed from the humerus neck with a wire saw (or chisel). Flatten its stump and suture it with the surrounding fascia to ensure the forearm rotation function. 4. Extra-articular fusion: the elbow flexes at 90°, and a long 4cm long and 2cm wide longitudinal bone groove is drilled behind the lower part of the humerus in the upper part of the trochlear. A short groove is drilled at the top of the corresponding olecranon on the extension of the bone groove. The appropriate size of the bone graft is embedded in the trough, and the two ends are fixed on the ankle and the ulna by screws, and the loose and easy fragments are used to fill the gap between the joint and the bone graft. Loosen the tourniquet and stop the bleeding completely. Suture the triceps aponeurosis; the contractures are extended. The elbow joint is located at the midpoint of the upper limb and has a large leverage. It is easy to cause fracture of the bone graft or joint displacement. A special person is required to maintain the position during the operation. 5. Pre-displacement ulnar nerve: The ulnar nerve is enlarged and separated upward and downward, and moved to the inner anterior and posterior aspect of the elbow joint to prevent the occurrence of delayed ulnar nerve palsy. The wound is then rinsed and the incision is sutured layer by layer. Before and after the long arm plaster support, the elbow is fixed at the functional position (90° flexion elbow, neutral position of the forearm).