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五十岁以下患者肘关节退行性关节炎的关节镜下尺肱关节置换术

Arthroscopic ulnohumeral arthroplasty for degenerative arthritis of the elbow in patients under fifty years of age.

作者信息

Krishnan Sumant G, Harkins David C, Pennington Scott D, Harrison Donnis K, Burkhead Wayne Z

机构信息

Shoulder and Elbow Service, W. B. Carrell Memorial Clinic, Dallas, TX 75231, USA.

出版信息

J Shoulder Elbow Surg. 2007 Jul-Aug;16(4):443-8. doi: 10.1016/j.jse.2006.09.001. Epub 2007 Jan 24.

Abstract

Degenerative arthritis of the elbow in patients aged under 50 years can cause disabling pain, severely restricted range of motion (ROM), and functional limitations. Open ulnohumeral arthroplasty has been demonstrated to produce satisfactory pain relief and ROM gains. We report the results of an all-arthroscopic ulnohumeral arthroplasty for degenerative arthritis of the elbow in younger patients. Eleven consecutive patients aged under 50 years with radiographically documented degenerative elbow arthritis underwent an all-arthroscopic ulnohumeral arthroplasty as described by Savoie et al. Indications for surgery were pain and limited ROM refractory to 12 months of conservative treatment. The mean age at the time of surgery was 36 years (range, 23-47 years). The minimum postoperative follow-up was 24 months, with a mean of 26 months (range, 24-29 months). Preoperatively, mean flexion was 100 degrees (range, 70 degrees-140 degrees) and mean extension (short of neutral) was 40 degrees (range, 10 degrees-60 degrees). Postoperatively, mean flexion was 140 degrees (range, 130 degrees-150 degrees; P < .01) and mean extension was 7 degrees (range, 0 degrees-20 degrees; P < .01). The total arc of motion averaged 60 degrees preoperatively and 133 degrees postoperatively (improvement of 73 degrees, P < .01). The mean subjective pain level improved from 9.2 to 1.7 (where 10 indicates worst pain and 0 indicates no pain). Mean subjective patient satisfaction improved from 1.8 to 9.0 (where 0 indicates unsatisfied and 10 indicates completely satisfied). All-arthroscopic ulnohumeral arthroplasty provides significant short-term pain relief, as well as restoration of elbow ROM and function, in patients aged under 50 years with degenerative arthritis of the elbow. The long-term durability of this procedure with regard to preservation of ROM and radiographic progression of arthritis remains unknown.

摘要

50岁以下患者的肘关节退行性关节炎可导致致残性疼痛、严重受限的活动范围(ROM)及功能受限。开放性尺肱关节置换术已被证明能带来令人满意的疼痛缓解及活动范围增加。我们报告了针对年轻患者肘关节退行性关节炎行全关节镜下尺肱关节置换术的结果。11例连续的50岁以下经影像学证实患有肘关节退行性关节炎的患者接受了Savoie等人描述的全关节镜下尺肱关节置换术。手术指征为经12个月保守治疗后疼痛及活动范围受限仍无改善。手术时的平均年龄为36岁(范围23 - 47岁)。术后最短随访时间为24个月,平均26个月(范围24 - 29个月)。术前,平均屈曲角度为100度(范围70度 - 140度),平均伸展(未达中立位)角度为40度(范围10度 - 60度)。术后,平均屈曲角度为140度(范围130度 - 150度;P < .01),平均伸展角度为7度(范围0度 - 20度;P < .01)。术前平均活动总弧度数为60度,术后为133度(改善73度,P < .01)。平均主观疼痛程度从9.2改善至1.7(10表示最严重疼痛,0表示无疼痛)。患者平均主观满意度从1.8提高至9.0(0表示不满意,10表示完全满意)。全关节镜下尺肱关节置换术为50岁以下患有肘关节退行性关节炎的患者提供了显著的短期疼痛缓解,以及肘关节活动范围和功能的恢复。该手术在维持活动范围及关节炎影像学进展方面的长期耐久性仍未知。

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