McKee Michael D, Pugh David M W, Richards Robin R, Pedersen Elizabeth, Jones Caroline, Schemitsch Emil H
Department of Surgery, St. Michael's Hospital and the University of Toronto, Ontario, Canada.
J Bone Joint Surg Am. 2003 May;85(5):802-7. doi: 10.2106/00004623-200305000-00005.
Under certain conditions it is standard practice to excise ununited humeral condyles during insertion of a semiconstrained total elbow prosthesis. Since the osseous origins of the common extensors and flexor-pronator muscles are lost, it has been postulated that this excision has a negative effect on strength. We are not aware of any previous study in which this issue has been investigated with use of standardized, objective testing of muscle strength.
We used objective testing to determine the effect of condylar resection on the muscle strength of the elbow, forearm, wrist, and hand in thirty-two patients who had undergone total elbow arthroplasty. To eliminate bias, the normal, contralateral limb served as the control, and all strength values are given as a percentage of the normal side. The humeral condyles were intact in sixteen patients and had been resected in the other sixteen. Patient demographics were similar in the two groups.
There were no significant differences between the two groups with regard to strength of pronation (103% of the normal side in the group with intact condyles compared with 89% in the group with resection of the condyles; p = 0.40), supination (68% compared with 89%; p = 0.49), wrist flexion (66% compared with 56%; p = 0.46), wrist extension (75% compared with 65%; p = 0.40), or grip strength (83% compared with 72%; p = 0.40). There was also no difference between the two groups with regard to the Mayo Elbow Performance Score (79 points in the group with intact condyles compared with 77 points in the group with resection of the condyles; p = 0.67).
Condylar resection has a minimal, clinically irrelevant effect on forearm, wrist, and hand strength and no effect on the Mayo Elbow Performance Score following total elbow arthroplasty. Thus, the findings of our study support the practice of condylar resection, which simplifies total elbow arthroplasty for many conditions.
在某些情况下，在植入半限制性全肘关节假体时切除不愈合的肱骨髁是标准操作。由于常见伸肌和屈肌 - 旋前肌的骨性起点丧失，有人推测这种切除会对力量产生负面影响。我们不知道此前有任何研究使用标准化的、客观的肌肉力量测试来调查这个问题。
我们通过客观测试来确定髁切除对32例接受全肘关节置换术患者的肘、前臂、腕和手部肌肉力量的影响。为消除偏差，将正常的对侧肢体作为对照，所有力量值均以正常侧的百分比表示。16例患者的肱骨髁完整，另外16例的肱骨髁已被切除。两组患者的人口统计学特征相似。
两组在旋前力量（完整髁组为正常侧的103%，髁切除组为89%；p = 0.40）、旋后力量（分别为68%和89%；p = 0.49）、腕屈曲力量（分别为66%和56%；p = 0.46）、腕伸展力量（分别为75%和65%；p = 0.40）或握力（分别为83%和72%；p = 0.40）方面均无显著差异。两组在梅奥肘关节功能评分方面也无差异（完整髁组为79分，髁切除组为77分；p = 0.67）。
髁切除对全肘关节置换术后前臂、腕和手部力量的影响极小，在临床上无相关性，对梅奥肘关节功能评分也无影响。因此，我们的研究结果支持髁切除的操作，这在许多情况下简化了全肘关节置换术。
