Wright T W, Wong A M, Jaffe R
Department of Orthopaedic Surgery, University of Florida, Box 100246 JHMHC, Gainesville, FL 32610-0246, USA.
J Shoulder Elbow Surg. 2000 Nov-Dec;9(6):524-31. doi: 10.1067/mse.2000.109408.
Twenty-six patients, each of whom had undergone either a semiconstrained (linked) or an unconstrained (unlinked) total elbow arthroplasty, were examined specifically to evaluate the restoration of function with respect to activities of daily living. The functional outcomes of these 2 groups were then compared to identify any significant differences. All of the unlinked/unconstrained prostheses were Ewald total elbow arthroplasties; the linked/semiconstrained prostheses, all of which were performed by a single surgeon, were Mayo-Coonrad prostheses. Follow-up radiographs, taken to rule out loosening or failure of the prosthesis as a cause for functional deficits, were available for review for 25 elbows. There were 14 elbows in 13 patients who had semiconstrained prostheses and 12 elbows in 10 patients who had unconstrained total prostheses. Average age at the time of elbow replacement surgery was 62.8 years (range, 47-75 years) for the semiconstrained group and 63.1 years (range, 54-74 years) for the unconstrained group. The semiconstrained group consisted of 8 female and 6 male elbows; the unconstrained group consisted of 10 female and 2 male elbows. Follow-up averaged 35.5 months (range, 24-73 months) in the semiconstrained group and 73 months (range, 27-110 months) in the unconstrained group. Twenty-two operations were performed for rheumatoid arthritis, 3 for posttraumatic humeral nonunion, and 1 for posttraumatic degenerative arthritis. Two elbows required revision, one (in the semiconstrained group) for aseptic loosening and the other (in the unconstrained group) for metal synovitis and pain from a chronically dislocated prosthesis; both of these elbows were considered failures and excluded from the functional comparison. No significant differences in functional performance were found, and no elbows demonstrated progressive radiolucencies suggestive of loosening. With the exception of 1 patient (in addition to the patients who had revisions) with a dislocated unconstrained prosthesis, all patients were satisfied with the procedure. It appears that when it is properly performed, total elbow arthroplasty with either type of prosthesis yields satisfactory functional results.
26例患者接受了半限制型（链接式）或非限制型（非链接式）全肘关节置换术，对其进行专门检查以评估日常生活活动功能的恢复情况。然后比较这两组的功能结果，以确定是否存在任何显著差异。所有非链接式/非限制型假体均为Ewald全肘关节置换假体；链接式/半限制型假体均由同一位外科医生操作，为Mayo-Coonrad假体。为排除假体松动或失败作为功能缺陷原因而拍摄的随访X光片可供25个肘关节复查。13例患者的14个肘关节采用了半限制型假体，10例患者的12个肘关节采用了非限制型全假体。半限制型组肘关节置换手术时的平均年龄为62.8岁（范围47 - 75岁），非限制型组为63.1岁（范围54 - 74岁）。半限制型组包括8个女性和6个男性肘关节；非限制型组包括10个女性和2个男性肘关节。半限制型组的随访平均为35.5个月（范围24 - 73个月），非限制型组为73个月（范围27 - 110个月）。22例手术是针对类风湿性关节炎进行的，3例是针对创伤后肱骨不愈合，1例是针对创伤后退行性关节炎。2个肘关节需要翻修，1个（在半限制型组）是无菌性松动，另1个（在非限制型组）是金属滑膜炎以及慢性脱位假体引起的疼痛；这2个肘关节均被视为失败病例并被排除在功能比较之外。未发现功能表现有显著差异，也没有肘关节显示出提示松动的进行性透光线。除1例（除了进行翻修的患者）非限制型假体脱位的患者外，所有患者对手术都很满意。似乎当手术操作得当，使用任何一种假体进行全肘关节置换术都能产生令人满意的功能结果。
