Larson A Noelle, Morrey Bernard F
Department of Orthopedic Surgery, Mayo Clinic, 200 First Street S.W., Rochester, MN 55905, USA.
J Bone Joint Surg Am. 2008 Dec;90(12):2714-23. doi: 10.2106/JBJS.G.00768.
Interposition arthroplasty is often considered to be a salvage option for the treatment of severe elbow arthritis when conservative treatment has failed and total joint replacement is contraindicated. The present retrospective study summarizes the results of a specific interposition arthroplasty technique for the treatment of inflammatory and posttraumatic arthritis of the elbow.
Between 1996 and 2003, sixty-nine elbows were treated with interposition arthroplasty with an Achilles tendon allograft. Forty-five elbows, including eleven with inflammatory arthritis and thirty-four with posttraumatic arthritis, met our inclusion criteria. The mean patient age was thirty-nine years. The mean duration of clinical follow-up was 6.0 years. Seven patients subsequently underwent revision surgery and were excluded from the analysis. For the thirty-eight remaining patients with surviving allografts, the current Mayo Elbow Performance Score and Disabilities of the Arm, Shoulder and Hand score were obtained and the most recent clinical outcomes and radiographs were reviewed.
In the group of thirty-eight patients with surviving allografts, the mean flexion-extension arc improved from 51 degrees preoperatively to 97 degrees postoperatively (p < 0.001). The mean Mayo Elbow Performance Score improved from 41 points preoperatively to 65 points postoperatively (p < 0.0001). Thirteen patients had a good or excellent result, fourteen had a fair result, and eleven had a poor result; the remaining seven had a revision. On the basis of the Mayo Elbow Performance Score, twelve patients rated the elbow as somewhat better and nineteen rated the elbow as much better following the interposition procedure. Despite efforts to reconstruct the collateral ligaments, preoperative instability on physical examination (found in eleven patients) was associated with low Mayo Elbow Performance Scores (p = 0.03) and high Disabilities of the Arm, Shoulder and Hand scores (p = 0.006). Four of five patients undergoing reconstruction of both collateral ligaments had a net decrease in the Mayo Elbow Performance Score.
We consider interposition elbow arthroplasty to be a salvage procedure as it neither completely eliminates pain nor restores full function. It may be indicated for young active patients with severe inflammatory or posttraumatic arthritis, especially those with limited elbow motion. Furthermore, we do not recommend this procedure when patients present with preoperative instability on physical examination.
当保守治疗失败且全关节置换术为禁忌时，间置关节成形术常被视为治疗严重肘关节关节炎的一种挽救性选择。本回顾性研究总结了一种用于治疗肘关节炎性和创伤后关节炎的特定间置关节成形术技术的结果。
1996年至2003年间，69例肘关节接受了同种异体跟腱间置关节成形术治疗。45例肘关节符合纳入标准，其中11例为炎性关节炎，34例为创伤后关节炎。患者平均年龄为39岁。临床随访平均时长为6.0年。7例患者随后接受了翻修手术，被排除在分析之外。对于其余38例同种异体移植物存活的患者，获取了当前的梅奥肘关节功能评分以及上肢、肩部和手部功能障碍评分，并回顾了最新的临床结果和X线片。
在38例同种异体移植物存活的患者组中，平均屈伸弧从术前的51度改善至术后的97度（p < 0.001）。梅奥肘关节功能评分平均从术前的41分提高至术后的65分（p < 0.0001）。13例患者结果为优或良，14例为中等，11例为差；其余7例接受了翻修手术。根据梅奥肘关节功能评分，12例患者认为肘关节在间置手术后有所改善，19例认为改善明显。尽管努力重建侧副韧带，但术前体格检查发现不稳定的11例患者梅奥肘关节功能评分较低（p = 0.03），上肢、肩部和手部功能障碍评分较高（p = 0.006）。5例双侧副韧带重建患者中有4例梅奥肘关节功能评分出现净下降。
我们认为间置肘关节成形术是一种挽救性手术，因为它既不能完全消除疼痛，也不能恢复全部功能。它可能适用于患有严重炎性或创伤后关节炎的年轻活跃患者，尤其是肘关节活动受限者。此外，当患者术前体格检查发现不稳定时，我们不推荐此手术。
