University of Missouri-Kansas City, Kansas City, MO, USA.
J Shoulder Elbow Surg. 2011 Mar;20(2):192-8. doi: 10.1016/j.jse.2010.09.010.
This study describes the rationale for, and tests the hypothesis that, a custom outrigger triflange ulnar component for revision total elbow arthroplasty would decrease the contact stresses at the bushings and overcome excessive bushing wear in active patients who have bone and ligamentous deficiency.
Five consecutive revisions for failed Coonrad-Morrey total elbow arthroplasties were performed with the custom outrigger triflange ulnar component for patients with accelerated bushing wear, ulnar component loosening, and deficient humeral condyles. The mean age at the time of surgery was 48 years (range, 32-64 years). Follow-up averaged 81 months (range, 65-124 months). The average number of previous operations was 2.4 (range, 2-3).
The Mayo Elbow Performance Score improved from 40 (range, 15-65) preoperatively to 91 (range, 80-100) at the latest follow-up. There were two excellent and three good results. There was no radiographic or clinical evidence of bushing wear at 6.8 years of follow-up (range, 5.5-10.3 years). One patient required further revision of the humeral component due to mechanical loosening, which had not been revised at the time of the index surgery.
A custom outrigger triflange ulnar component is an effective alternative for revising loose Coonrad-Morrey ulnar components in active patients with absent humeral epicondyles and accelerated bushing wear.
It may be an alternative to revision with standard components until improved surgical designs addressing this problem become commercially available.
本研究描述了一种用于翻修全肘人工关节的定制外臂三叶形尺骨组件的基本原理，并验证了其假设，即对于存在肱骨髁突缺失和关节衬套加速磨损的活动患者，该定制外臂三叶形尺骨组件可降低衬套的接触应力并克服关节衬套过度磨损。
对 5 例因关节衬套磨损加速、尺骨组件松动和肱骨髁发育不良而导致翻修失败的 Coonrad-Morrey 全肘人工关节置换术患者，使用定制外臂三叶形尺骨组件进行翻修。手术时的平均年龄为 48 岁（范围 32-64 岁）。随访平均时间为 81 个月（范围 65-124 个月）。平均手术次数为 2.4 次（范围 2-3 次）。
Mayo 肘关节功能评分由术前的 40 分（范围 15-65 分）提高至末次随访时的 91 分（范围 80-100 分）。2 例为优，3 例为良。在 6.8 年的随访中（范围 5.5-10.3 年），未见关节衬套磨损的影像学或临床证据。1 例患者因机械性松动需要进一步翻修肱骨组件，而该患者在初次手术时未进行翻修。
对于存在肱骨髁突缺失且关节衬套磨损加速的活动患者，定制外臂三叶形尺骨组件是一种有效的翻修方法，可替代松动的 Coonrad-Morrey 尺骨组件。
在解决这一问题的手术设计得到改进并商业化之前，该方法可能是标准组件翻修的替代方法。
