Department of Orthopedic Surgery, Asan Medical Center, School of Medicine, Ulsan University, Seoul, South Korea.
J Shoulder Elbow Surg. 2011 Sep;20(6):857-65. doi: 10.1016/j.jse.2011.03.005. Epub 2011 Jun 8.
Other than an awareness, there is little detailed information regarding wound problems after total elbow arthroplasty. The purpose of this study was to (1) determine the incidence of wound complications after elbow arthroplasty, (2) document the long-term implications, (3) characterize risk factors, and (4) discuss a management strategy. We hypothesize that the incidence of this complication can be reduced with careful preoperative planning.
We reviewed 1749 total elbow arthroplasties. The average patient age was 61.5 years (range; 30-91 years). Wound complications were diagnosed according to the criteria of the Centers for Disease Control and Prevention.
We identified and studied 97 patients (5.5%) from the 1749 procedures. The most common problems were delayed healing and drainage in 34 and wound hematoma in 33, of which 9 (27%) progressed to secondary deep infection. Of the 97 patients, 86 (88.7%) healed with the retention of the implant, 24 (∼25%) progressed to a septic elbow, and 11 (∼50%) required resection. Patients with rheumatoid arthritis represented 33% of the entire sample, but represented 45.8% of those with septic complications. Posttraumatic arthritis patients represented 58% of the entire sample and only 33% of those with septic problems (P < .05).
The overall incidence of serious wound complications was slightly less than anticipated; however, the significance was considerable. Patients with rheumatoid arthritis are most vulnerable. Persistent wound drainage showed a high correlation for deep infection and subsequent implant removal. Anticipation of potential problems and appropriate prophylactic management may avoid wound complications.
除了意识之外，关于全肘关节置换术后的伤口问题几乎没有详细的信息。本研究的目的是：(1)确定肘关节置换术后伤口并发症的发生率；(2)记录长期影响；(3)确定危险因素；(4)讨论管理策略。我们假设通过仔细的术前计划，可以减少这种并发症的发生。
我们回顾了 1749 例全肘关节置换术。平均患者年龄为 61.5 岁（范围 30-91 岁）。根据疾病控制和预防中心的标准诊断伤口并发症。
我们从 1749 例手术中发现并研究了 97 例（5.5%）患者。最常见的问题是 34 例愈合延迟和引流，33 例伤口血肿，其中 9 例（27%）进展为继发深部感染。在 97 例患者中，86 例（88.7%）保留植入物愈合，24 例（约 25%）进展为感染性肘，11 例（约 50%）需要切除。类风湿关节炎患者占整个样本的 33%，但占感染性并发症患者的 45.8%。创伤后关节炎患者占整个样本的 58%，但仅占感染性问题患者的 33%（P<.05）。
严重伤口并发症的总发生率略低于预期，但意义重大。类风湿关节炎患者最易受影响。持续的伤口引流与深部感染和随后的植入物移除有很高的相关性。对潜在问题的预期和适当的预防性管理可能避免伤口并发症。
