Loebenberg Mark I, Adams Robert, O'Driscoll Shawn W, Morrey Bernard F
Department of Orthopedic Surgery, Mayo Clinic and Mayo Foundation, Rochester, Minnesota 55905, USA.
J Bone Joint Surg Am. 2005 Jan;87(1):99-106. doi: 10.2106/JBJS.B.00038.
Revision total elbow arthroplasty is often undertaken in patients who have severe osteolysis of both the distal part of the humerus and the proximal part of the ulna. To deal with such bone loss, we have adopted the practice of impaction grafting, which has become a well-established technique in the proximal part of the femur.
We retrospectively reviewed the results of twelve patients who had undergone revision total elbow arthroplasty with impaction grafting between 1993 and 1997. There were eight women and four men with a mean age of fifty-seven years. All patients were followed for at least two years (range, twenty-five to 113 months), with an average duration of follow-up of seventy-two months. Seven of the patients had an initial diagnosis of rheumatoid arthritis, and five had posttraumatic arthritis. Impaction grafting was undertaken during the initial revision in three of the patients, whereas the remaining nine patients had undergone at least one prior revision without impaction grafting. Four patients had impaction grafting on the ulnar side alone, six had it on the humeral side alone, and two underwent impaction grafting of both the humerus and the ulna. Six allograft struts were placed to span structural defects in five patients.
At the time of the latest follow-up, eight of the elbow prostheses were intact after the index impaction grafting procedure. Two elbows had been revised because of loosening, and another had been revised because of a fracture of the ulnar component. A fourth patient had undergone a resection arthroplasty because of infection. The eight remaining patients demonstrated marked radiographic improvement in bone quality in the region of the impaction graft without clinical symptoms of loosening. At the time of the last follow-up, after an additional revision in three elbows, there were five excellent, four good, and three fair results.
Impaction grafting is a reliable technique for treating osteolysis in patients undergoing revision total elbow arthroplasty; however, complications can occur, and a high percentage of patients need additional surgery.
翻修全肘关节置换术常用于肱骨远端和尺骨近端严重骨溶解的患者。为应对此类骨量丢失问题，我们采用了打压植骨技术，该技术在股骨近端已成为一项成熟的技术。
我们回顾性分析了1993年至1997年间接受翻修全肘关节置换术并采用打压植骨的12例患者的结果。其中女性8例，男性4例，平均年龄57岁。所有患者均随访至少两年（范围为25至113个月），平均随访时间为72个月。7例患者最初诊断为类风湿关节炎，5例为创伤后关节炎。3例患者在初次翻修时进行了打压植骨，其余9例患者至少曾接受过一次未采用打压植骨的翻修手术。4例患者仅在尺骨侧进行了打压植骨，6例仅在肱骨侧进行了打压植骨，2例患者肱骨和尺骨均进行了打压植骨。5例患者放置了6根同种异体骨支柱以跨越结构性缺损。
在最近一次随访时，8例肘关节假体在初次打压植骨手术后保持完好。有2例肘关节因松动而进行了翻修，另一例因尺骨部件骨折而进行了翻修。第4例患者因感染接受了切除成形术。其余8例患者在打压植骨区域骨质量在影像学上有明显改善，且无松动的临床症状。在最后一次随访时，3例肘关节再次翻修后，结果为优5例、良4例、可3例。
打压植骨是治疗翻修全肘关节置换术患者骨溶解的可靠技术；然而，可能会出现并发症，且有相当比例的患者需要再次手术。
