Department of Orthopedics, Mayo Clinic, 200 First Street S.W., Rochester, MN 55905, USA.
J Bone Joint Surg Am. 2010 Nov 3;92(15):2576-82. doi: 10.2106/JBJS.I.00577.
Elbow resection is a salvage procedure typically considered as a last resort in the case of refractory infection following total elbow arthroplasty. The goal of this study was to evaluate the long-term outcome of patients following resection arthroplasty for the treatment of a failed total elbow replacement.
Between 1975 and 2005, fifty-one consecutive elbows (fifty patients) were treated with resection for a deep infection following total elbow arthroplasty with either linked or unlinked implants. The average age at the time of arthroplasty was fifty-two years, and the average age at the time of elbow resection arthroplasty was fifty-nine years. Twenty-nine patients (thirty elbows) were contacted at an average of eleven years (range, 2.7 to twenty-eight years) postoperatively, and their outcomes were graded with use of the Mayo Elbow Performance Score and the Disabilities of the Arm, Shoulder and Hand (DASH) score. The remaining twenty patients (twenty-one elbows) had either died (sixteen elbows) or declined follow-up (five elbows) and so were included only in the analysis of complications and early outcome.
Elbow resection resulted in an improvement in the Mayo Elbow Performance Score, from a preoperative value of 37 points to a final follow-up value of 60 points (a poor to fair result) for the twenty-nine patients contacted at long term (p < 0.05). Most of the increase in the Mayo Elbow Performance Score resulted from improvements in the pain component of the score. Of the thirty elbows in patients who had been followed long term, eight had good results; eleven, fair results; and eleven, poor results. The DASH score averaged 71 points (range, 51 to 91 points). Complications were common and included infections in twenty-four elbows (47%), intraoperative fractures in eighteen (35%), and permanent nerve injury in nine elbows (18%). Stability after resection correlated with a better long-term Mayo Elbow Performance Score (p < 0.05).
Resection arthroplasty is a salvage option in patients with refractory infection after a total elbow arthroplasty and should be considered only when all other attempts to eradicate the infection have failed.
肘切除术是一种挽救性手术，通常被认为是全肘置换术后难治性感染的最后手段。本研究的目的是评估全肘置换术后感染失败患者行切除成形术的长期疗效。
1975 年至 2005 年间，51 例（50 例）连续肘（50 例）因全肘置换术后感染行切除成形术治疗，其中包括带或不带连接装置的植入物。关节置换时的平均年龄为 52 岁，肘切除成形术时的平均年龄为 59 岁。29 例（30 肘）平均随访 11 年（2.7 至 28 年）后进行评估，采用 Mayo 肘功能评分和上肢残疾评分（DASH）进行评分。其余 20 例（21 肘）患者因死亡（16 肘）或拒绝随访（5 肘）而仅纳入并发症和早期结果分析。
肘切除术后，29 例（30 肘）长期随访患者的 Mayo 肘功能评分从术前的 37 分提高到末次随访的 60 分（差至尚可）（p < 0.05）。 Mayo 肘功能评分的提高主要来自于评分中疼痛部分的改善。长期随访的 30 肘患者中，8 例疗效良好，11 例疗效尚可，11 例疗效差。DASH 评分平均为 71 分（51 至 91 分）。并发症常见，包括 24 肘（47%）感染、18 肘（35%）术中骨折和 9 肘（18%）永久性神经损伤。切除后稳定性与长期 Mayo 肘功能评分较好相关（p < 0.05）。
肘切除术是全肘置换术后难治性感染的挽救性选择，只有在所有其他消除感染的尝试都失败后才应考虑。
