Fehringer Edward V, Burns Erica M, Knierim Annie, Sun Junfeng, Apker Kimberly A, Berg Robert E
Departments of Orthopaedic Surgery & Rehabilitation, University of Nebraska Medical Center, Omaha, NE 68198-1080, USA.
J Shoulder Elbow Surg. 2009 Mar-Apr;18(2):275-8. doi: 10.1016/j.jse.2008.09.012. Epub 2008 Dec 3.
Radiolucencies surrounding the stems of smooth-stemmed metal radial head prostheses placed for comminuted radial head fractures are associated with proximal radial forearm pain.
Patients in whom 18 consecutive elbows that underwent metal radial head replacement with smooth stems for comminuted radial head fractures were assessed at least two years after surgery. Proximal radial forearm pain was assessed with a visual analog score (0-10) and elbow function with a Mayo index. "Mean stem radiolucency" was determined by two musculoskeletal radiologists based upon three radiographs of each elbow: a lateral in maximum extension, a lateral in maximum flexion, and an antero-posterior.
All elbows were stable and stem radiolucencies were present in 16 of the 17 available for study. "Mean stem radiolucency" did not correlate with proximal radial forearm pain (p = 0.63) or Mayo scores (p = 0.37) using Spearman's correlation coefficients. 6/17 prostheses were in patients that rated their pain level as 0; 11/17 were in patients that rated their pain as at least 1 with 5 being the highest. Using the Signed Rank test, operative elbows had less motion for both flexion/extension (p = 0.0001) and pronation/supination (p = 0.01) compared to non-operative elbows from the same patient.
"Mean stem radiolucency" did not correlate with proximal radial forearm pain. However, proximal radial forearm pain was present in 11/17 elbows based upon visual analog scores. Proximal radial forearm pain in this population may have several etiologies.
"Mean stem radiolucencies" surrounding smooth-stemmed metal radial head prostheses for fractures did not correlate with proximal radial forearm pain scores.
Level 4; Retrospective case series, no control group.
因粉碎性桡骨头骨折而植入的光滑柄金属桡骨头假体柄周围的透亮区与桡骨近端前臂疼痛相关。
对连续18例因粉碎性桡骨头骨折接受光滑柄金属桡骨头置换术的患者的肘部进行术后至少两年的评估。采用视觉模拟评分（0 - 10分）评估桡骨近端前臂疼痛情况，采用梅奥指数评估肘部功能。由两名肌肉骨骼放射科医生根据每个肘部的三张X线片确定“平均柄透亮区”：最大伸展位的侧位片、最大屈曲位的侧位片和前后位片。
所有肘部均稳定，17例可供研究的病例中有16例存在柄透亮区。使用Spearman相关系数，“平均柄透亮区”与桡骨近端前臂疼痛（p = 0.63）或梅奥评分（p = 0.37）均无相关性。17例假体中有6例患者将疼痛程度评为0分；17例中有11例患者将疼痛评为至少1分，最高分为5分。采用符号秩检验，与同一患者的非手术肘部相比，手术肘部的屈伸（p = 0.0001）和旋前/旋后（p = 0.01）活动度较小。
“平均柄透亮区”与桡骨近端前臂疼痛无关。然而，根据视觉模拟评分，17例肘部中有11例存在桡骨近端前臂疼痛。该人群中桡骨近端前臂疼痛可能有多种病因。
用于骨折的光滑柄金属桡骨头假体周围的“平均柄透亮区”与桡骨近端前臂疼痛评分无关。
4级；回顾性病例系列，无对照组。
