van der Lugt J C T, Geskus R B, Rozing P M
Department of General Surgery, Reinier de Graaf Gasthuis, P.O. Box 5011, NL-2600 GA Delft, The Netherlands.
J Bone Joint Surg Am. 2005 Mar;87 Suppl 1(Pt 1):67-77. doi: 10.2106/JBJS.D.02734.
BACKGROUND: Total elbow arthroplasty is a well-established treatment for the painful elbow joint in patients with rheumatoid arthritis. We present the results of what we believe to be the first prospective study of the Souter-Strathclyde total elbow prosthesis. METHODS: Between June 1982 and December 2000, 204 primary total elbow prostheses were inserted in 166 patients who had rheumatoid arthritis. No patient was lost to follow-up. The mean duration of follow-up was 6.4 years. All patients were examined preoperatively, at one and two years postoperatively, and at regular intervals thereafter. RESULTS: Six of the 204 elbows had pain at rest at the time of the latest follow-up. Ten patients (ten elbows) without previous neurological symptoms had development of paresthesias in the distribution of the ulnar nerve postoperatively. Patients who had pain at rest or at night and those who had ulnar nerve symptoms preoperatively were found to have a significant chance of having the same complaints postoperatively. Pain at rest or at night and a decrease in function during the follow-up period were associated with humeral loosening. Twenty-four elbows had revision of the total elbow prosthesis because of loosening of the humeral component (ten), loosening after fracture (six), dislocation (four), infection (two), restricted range of motion (one), or fracture of the middle part of the humeral shaft, proximal to the prosthesis (one). One prosthesis was removed because of humeral loosening, and eight were removed because of deep infection. Another five prostheses were radiographically loose at the time of the latest follow-up. The rate of implant survival, according to the method of Kaplan-Meier, was 77.4% after ten years and 65.2% after eighteen years. CONCLUSIONS: Total elbow replacement is associated with a high complication rate and therefore may be warranted only for seriously disabled patients. Currently, the results associated with the Souter-Strathclyde total elbow prosthesis are comparable with the results associated with other prostheses, but loosening of the humeral component remains a concern.
背景：全肘关节置换术是治疗类风湿性关节炎患者疼痛肘关节的一种成熟疗法。我们展示了我们认为是关于Souter-Strathclyde全肘关节假体的第一项前瞻性研究的结果。 方法：在1982年6月至2000年12月期间，为166例类风湿性关节炎患者植入了204个初次全肘关节假体。没有患者失访。平均随访时间为6.4年。所有患者在术前、术后1年和2年以及此后定期接受检查。 结果：在最近一次随访时，204个肘关节中有6个在休息时疼痛。10例（10个肘关节）术前无神经症状的患者术后出现尺神经分布区感觉异常。术前休息时或夜间疼痛以及有尺神经症状的患者术后出现相同症状的可能性很大。休息时或夜间疼痛以及随访期间功能下降与肱骨松动有关。24个肘关节因肱骨部件松动（10个）、骨折后松动（6个）、脱位（4个）、感染（2个）、活动范围受限（1个）或假体近端肱骨干中部骨折（1个）而进行了全肘关节假体翻修。1个假体因肱骨松动而取出，8个因深部感染而取出。在最近一次随访时，另有5个假体在放射学上松动。根据Kaplan-Meier方法，植入物10年后的生存率为77.4%，18年后为65.2%。 结论：全肘关节置换术并发症发生率高，因此可能仅适用于严重残疾患者。目前，Souter-Strathclyde全肘关节假体的结果与其他假体的结果相当，但肱骨部件的松动仍然是一个问题。
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