Celli Andrea, Morrey Bernard F
Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota 55905, USA.
J Bone Joint Surg Am. 2009 Jun;91(6):1414-8. doi: 10.2106/JBJS.G.00329.
It is generally accepted that prosthetic elbow replacement should be avoided in young patients because of an anticipated high rate of early failure. The purpose of this paper was to define the success, prosthetic survival rate, and problems encountered in patients who were treated with a semiconstrained total elbow arthroplasty when they were forty years of age or less.
We retrospectively reviewed the records of 758 patients who had undergone primary arthroplasty with the Coonrad-Morrey total elbow prosthesis for any reason between 1982 and 2003. We identified fifty-five total elbow arthroplasties that had been performed in forty-nine patients (thirty-eight women and eleven men) who were forty years of age or less (mean, thirty-three years) at the time of the operation and that had been followed for a minimum of five years. Six patients had a bilateral procedure. The indication for the arthroplasty was inflammatory arthritis in thirty patients and posttraumatic arthritis in nineteen. Patients with hemophilia or a neoplasm were excluded. The medical record data were used to calculate the preoperative and postoperative Mayo Elbow Performance Score.
The mean duration of follow-up was ninety-one months. During this period, twelve (22%) of the elbows had undergone a subsequent surgical procedure: four because of loosening, three because of triceps weakness, three because of wear, and two because of deep infection. On the basis of the Mayo Elbow Performance Score at the last review, thirty-six results (65%) were considered to be excellent; fifteen (27%), good; three (5%), fair; and one (2%), poor.
Semiconstrained total elbow arthroplasty in young patients was associated with a 22% revision rate at a mean of ninety-one months, and the rate of revision was significantly higher for patients with posttraumatic arthritis. Despite this revision rate, fifty-one elbows (93%) had a good or excellent Mayo Elbow Performance Score.
由于预计早期失败率较高，一般认为年轻患者应避免进行人工肘关节置换。本文的目的是确定年龄在40岁及以下接受半限制型全肘关节置换术的患者的手术成功率、假体生存率及所遇到的问题。
我们回顾性分析了1982年至2003年间因任何原因接受Coonrad-Morrey全肘关节假体初次置换术的758例患者的记录。我们确定了49例患者（38例女性和11例男性）接受的55例全肘关节置换术，这些患者在手术时年龄在40岁及以下（平均33岁），且随访时间至少为5年。6例患者接受了双侧手术。置换术的适应证为30例炎性关节炎和19例创伤后关节炎。血友病或肿瘤患者被排除。病历数据用于计算术前和术后的梅奥肘关节功能评分。
平均随访时间为91个月。在此期间，12例（22%）肘关节接受了二次手术：4例因松动，3例因三头肌无力，3例因磨损，2例因深部感染。根据最后一次评估时的梅奥肘关节功能评分，36例（65%）结果为优；15例（27%）为良；3例（5%）为中；1例（2%）为差。
年轻患者的半限制型全肘关节置换术在平均91个月时的翻修率为22%，创伤后关节炎患者的翻修率显著更高。尽管有这个翻修率，但51例（93%）肘关节的梅奥肘关节功能评分为良或优。
