Schneeberger A G, Meyer D C M
Orthopädische Universitätsklinik Balgrist, Zürich.
Ther Umsch. 2002 Oct;59(10):550-6. doi: 10.1024/0040-5930.59.10.550.
Previously used total elbow prostheses were mainly constrained hinged implants. Their early clinical results were favourable but they failed due to a high rate of loosening already a few years after implantation. The cause for the early loosening was the great forces across the elbow joint which were directly transmitted to the prosthesis-bone interface in these implants. Therefore, these implants were abandoned. Afterwards, unlinked, semiconstrained or non-constrained resurfacing devices were introduced. In these devices, the soft tissues constrain the joint and therefore absorb part of the transmitted forces. The rates of loosening were significantly improved and rarely the cause of early failure. But resurfacing implants require intact condyles and collateral ligaments. These implants can, therefore, only be used in a limited number of indications, and postoperative instabilities are known complications. The currently most frequently used device is the semiconstrained Coonrad-Morrey prosthesis. It is a floppy hinge which allows valgus-varus and rotational laxities. Therefore, a part of the forces across the elbow joint are absorbed by the soft tissues. The loosening rate is not a clinical problem any more, and is with 4% 10 years after implantation (rheumatoid arthritis) similar to that of total hip or knee replacement. Furthermore, this device is stabilised with a small anterior flange to the anterior cortex of the humeral shaft. Condyles and collateral ligaments are therefore not necessary neither for short nor for long-term stability. The Coonrad-Morrey total elbow prosthesis can therefore be used for almost every indication, such as severe destruction of the elbow joint and even in case of complete loss of the distal humerus. The long-term outcome with this prosthesis for the treatment of rheumatoid arthritis is favourable with 96% of very good and good results. Function is restored with an average flexion of 131 degrees, a mean loss of extension of 28 degrees, and an unrestricted pronation and supination. The rate of complications for patients with rheumatoid arthritis is 10%. Similarly, the results for Coonrad-Morrey total elbow replacement for posttraumatic arthrosis are favourable with 83% of satisfactory results. Most patients consider their elbow as improved compared to preoperatively, but pain relief is obtained only in three quarters of the patients. The rate of complications is high with 30%, indicating the total elbow replacement is contraindicated for strenuous labour and sports activities.
以往使用的全肘关节假体主要是限制性铰链式植入物。它们早期的临床效果良好，但在植入后几年就因松动率高而失败。早期松动的原因是肘关节上的巨大力量直接传递到这些植入物的假体 - 骨界面。因此，这些植入物被淘汰。此后，出现了非连接式、半限制性或非限制性表面置换装置。在这些装置中，软组织约束关节，因此吸收部分传递的力量。松动率显著改善，很少成为早期失败的原因。但表面置换植入物需要完整的髁和侧副韧带。因此，这些植入物仅适用于有限的适应证，术后不稳定是已知的并发症。目前最常用的装置是半限制性的Coonrad - Morrey假体。它是一种柔性铰链，允许外翻 - 内翻和旋转松弛。因此，肘关节上的一部分力量被软组织吸收。松动率不再是临床问题，在植入后10年（类风湿性关节炎）时为4%，与全髋关节或膝关节置换相似。此外，该装置通过一个小的前凸缘固定在肱骨干的前皮质上。因此，无论是短期还是长期稳定性，髁和侧副韧带都不是必需的。因此，Coonrad - Morrey全肘关节假体几乎可用于各种适应证，如肘关节的严重破坏，甚至在肱骨远端完全缺失的情况下。该假体治疗类风湿性关节炎的长期效果良好，96%的结果为非常好和良好。功能得以恢复，平均屈曲度为131度，平均伸展丧失28度，旋前和旋后不受限。类风湿性关节炎患者的并发症发生率为10%。同样，Coonrad - Morrey全肘关节置换治疗创伤后关节炎的结果良好，83%的结果令人满意。大多数患者认为与术前相比，他们的肘关节有所改善，但只有四分之三的患者疼痛得到缓解。并发症发生率高达30%，表明全肘关节置换术不适用于体力劳动和体育活动。
