目的 探讨肘关节镜手术并发症发生情况及其原因.方法 回顾研究1998年6月～2008年11月269例肘关节镜中46例(17.1%)并发症的发生、处理及预后.男32例,女14例,年龄(32.9±15.1)岁(13～61岁).其中骨关节炎20例,关节粘连8例,肱骨外上髁炎4例,类风湿关节炎4例,急性创伤5例,肱骨内上髁炎1例,剥脱性骨软骨炎2例,色素绒毛结节性滑膜炎1例,肘关节不稳1例.最多见为一过性神经损伤36例,其中累及桡神经7例,尺神经7例,腋神经1例,肢体远端末梢神经感觉障碍21例;迟发性尺神经炎5例;伤口术后渗液1例,皮下血肿1例;残留游离体5例.2例肘关节发生了2种并发症.结果 36例一过性神经损伤患者中的32例在术后1～7天内缓解,最迟1例桡神经深支损伤术后8个月好转.3例迟发性尺神经炎行尺神经前移术,1例伤口血肿行血肿清除术,2例游离体残留行游离体二次取出术,余保守治疗,均治愈.结论肘关节镜的并发症以一过性神经损伤最多见,还有迟发性尺神经炎、伤口并发症、游离体残留.这些并发症绝大多数都是轻微可逆的,故肘关节镜是一种安全有效的技术.%Objective To investigate the major complications after elbow arthroscopy and their causes. Methods Though June 1998 to November 2008, we performed elbow arthroscopy on 269 patients, of whom, complications occurred in 46 cases [ 17. 1％ , 32 male and 14 female, aged 32.9 ± 15. 1 in average (13 to 61 years)]. We reviewed the occurrence, treatment, and prognosis of the complications. Among the 46 cases, osteoarthritis was found in 20 patients, flexion contracture in 8, rheumatoid synovitis in 4, tennis elbow in 4, acute trauma in 5, osteoarthritis dissecans in 2, humeral medial epicondylitis in 1, villonodular synovitis in 1, and elbow instability in 1. We noticed that the most common complication was transient neural injury (36 cases), including injury to the musculospiral nerve (7 cases) , ulnar nerve (7 cases) , axillary nerve ( 1 case) , and sensory disturbance in the ending nerve (21 cases). Other complications included late ulnar neuropathy (5 cases) , incisional effusion ( 1 case) , subcutaneous hematoma ( 1 case) , and residual free body (5 cases). In two cases ( two elbows) , two complications occurred at the same time. Results 32 of the 36 cases of transient neural injury recovered completely in 1 -7 days. In one patient, who had injury to the deeper branch of the musculospiral nerve, recovered in 8 months. Anterior transposition of the ulnar nerve was performed on 3 of the patients who had ulnar neuropathy, removal of the hematoma was carried out in one of them and the other who had residual free body received a second operation to remove the bodies; the other patients were cured by conversational treatment. Conclusions The major complications of arthroscopic procedures on the elbow are transient neural injury, followed by late ulnar neuropathy, incisional complications and residual free bodies. Most of the complications are mild and reversible, and thus we recommend elbow arthroscopy as a safe procedure.
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