Lamas Claudia, Castellanos Juan, Proubasta Ignacio, Dominguez Enrique
Hand (N Y). 2011 Mar;6(1):27-33. doi: 10.1007/s11552-010-9282-8. Epub 2010 Jun 15.
We had evaluated our experience in the treatment of displaced and comminuted radial head fractures with pyrocarbon radial head prosthesis.
From May 2003 to July 2008, radial head prostheses were performed in 47 patients. There were 29 female and 18 male with mean age 51 (34-70 years). The follow-up was a mean of 48 (12-60 months). Fractures of the radial head have been classified by Hotchkiss. The indications for a radial head replacement were type III fractures in 27 cases, type IV fractures in ten cases, comminuted radial fracture associated with disruption of the medial collateral ligament in three cases, Monteggia variant in five cases, and Essex-Lopresti in two cases. Functional outcomes were assessed by visual analog scales (VAS) of pain, joint motion and stability, and using the Mayo Elbow Performance Index.
The mean VAS score for elbow pain was 1 (0.5-2.1). Patients showed an average arc of motion from 6° to 140°, with 75° of pronation and 67° of supination. By using the Mayo Elbow Performance Index, 42 patients had good/excellent results, with three fair and two poor outcomes. Complications were two implant dislocations, one elbow stiffness, one dissociation of the implant, one stem rupture, and two posterior interosseous nerve palsy that recovered from 5 to 8 weeks. We had not seen persistent instability, infection, synostosis, severe degenerative changes, or impingement.
The treatment of comminuted radial head fracture with pyrocarbon implant usually gives an optimal result depending on the severity of the initial injury and the presence of associated lesions. The size of the prosthesis is often overestimated, causing restriction in motion due to impingement, overstuffing, or dislocations.
我们评估了使用热解碳桡骨头假体治疗移位和粉碎性桡骨头骨折的经验。
2003年5月至2008年7月,对47例患者实施了桡骨头假体植入术。其中女性29例,男性18例,平均年龄51岁(34 - 70岁)。平均随访时间为48个月(12 - 60个月)。桡骨头骨折按霍奇基斯分类法进行分类。桡骨头置换的指征包括:Ⅲ型骨折27例,Ⅳ型骨折10例,粉碎性桡骨骨折合并内侧副韧带损伤3例,孟氏变异型5例,埃斯克斯-洛普雷斯蒂损伤2例。通过疼痛视觉模拟量表(VAS)、关节活动度和稳定性以及梅奥肘关节功能指数评估功能结果。
肘关节疼痛的平均VAS评分为1分(0.5 - 2.1)。患者的平均活动弧度为6°至140°,旋前75°,旋后67°。根据梅奥肘关节功能指数,42例患者结果为良好/优秀,3例为中等,2例为差。并发症包括2例植入物脱位、1例肘关节僵硬、1例植入物分离、1例柄部断裂以及2例骨间后神经麻痹,均在5至8周内恢复。未发现持续性不稳定、感染、骨融合、严重退变或撞击。
根据初始损伤的严重程度和相关损伤的情况,使用热解碳植入物治疗粉碎性桡骨头骨折通常能取得最佳效果。假体尺寸常常被高估,因撞击、填充过多或脱位导致活动受限。