在因无菌性松动和骨丢失导致的翻修全肘置换术中的嵌压植骨。

Impaction grafting in revision total elbow arthroplasty due to aseptic loosening and bone loss.

机构信息

Shoulder & Elbow Clinic, Department of Orthopaedic Surgery, College of Medicine, Kyung Hee University, 1 Hoegi-dong, Dongdaemun-gu, Seoul 130-702, South Korea.

出版信息

J Bone Joint Surg Am. 2013 Jun 5;95(11):e741-7. doi: 10.2106/JBJS.K.01737.

DOI:10.2106/JBJS.K.01737

PMID:23780544

Abstract

BACKGROUND

With the increase in the number of total elbow arthroplasties being performed, there has been a parallel increase in revision surgery. There is limited information about the outcome of impaction grafting following failed elbow arthroplasty.

METHODS

We retrospectively analyzed sixteen cases of revision arthroplasty performed following aseptic loosening of a semiconstrained total elbow replacement. There were three men and thirteen women with a mean age of 58.4 years (range, twenty-eight to seventy-five years). Fourteen elbows had loosening of both the humeral and the ulnar component, and two elbows had only humeral loosening. Two elbows had perforation of the humeral cortex by the humeral component, and one had perforation of the ulnar cortex. Grade-II bone loss as described by King et al. was found in three elbows; grade III, in six elbows; and grade IV, in seven elbows. The impaction grafting was performed with only allograft in thirteen elbows, and it was done with allograft as well as autograft from the iliac crest in the other three elbows. The mean duration of follow-up was 7.4 years (range, 4.1 to 11.2 years).

RESULTS

The mean Mayo Elbow Performance Score (MEPS) for pain significantly improved from 15.0 points preoperatively to 32.8 points at the time of latest follow-up (p = 0.003). The mean arc of flexion also significantly increased, from 60.3° to 115.6° (p < 0.01). Stability according to the MEPS significantly increased from a mean of 2.2 points to a mean of 9.4 points (p = 0.001). The mean total MEPS improved from 41.0 points to 82.8 points (p = 0.001). The result was excellent for four elbows, good for eleven, and fair for one. Follow-up radiographs demonstrated fifteen cases with grade-I resorption of the bone graft and one case with grade-II resorption. A type-I radiolucent line was observed in twelve of the elbows; type II, in three; and type IV, in one. Additional surgery was required in two cases.

CONCLUSIONS

Impaction grafting is an effective technique when revision total elbow arthroplasty is used for the treatment of aseptic loosening with bone loss.

LEVEL OF EVIDENCE

Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.

摘要

背景

随着全肘关节置换术数量的增加，翻修手术也随之增加。关于全肘关节置换术后骨水泥填充失败的结果信息有限。

方法

我们回顾性分析了 16 例因半限制型全肘置换术后无菌性松动而进行翻修的病例。其中男性 3 例，女性 13 例，平均年龄 58.4 岁（28 岁至 75 岁）。14 例肘关节同时出现肱骨和尺骨组件松动，2 例仅出现肱骨组件松动。2 例肘关节肱骨皮质被肱骨组件穿透，1 例尺骨皮质穿透。根据 King 等的描述，发现 3 例为Ⅱ级骨丢失，6 例为Ⅲ级骨丢失，7 例为Ⅳ级骨丢失。13 例仅采用同种异体骨进行骨水泥填充，另外 3 例采用同种异体骨和髂嵴自体骨进行骨水泥填充。平均随访时间为 7.4 年（4.1 年至 11.2 年）。

结果

术前平均 Mayo 肘关节功能评分（MEPS）的疼痛评分从 15.0 分显著改善至末次随访时的 32.8 分（p = 0.003）。平均屈伸弧也显著增加，从 60.3°增加至 115.6°（p < 0.01）。根据 MEPS 评估的稳定性从平均 2.2 分显著增加至平均 9.4 分（p = 0.001）。总的 MEPS 评分从 41.0 分提高至 82.8 分（p = 0.001）。结果为优 4 例，良 11 例，可 1 例。随访 X 线片显示 15 例骨移植有Ⅰ级吸收，1 例有Ⅱ级吸收。12 例出现Ⅰ型透亮线，3 例出现Ⅱ型，1 例出现Ⅳ型。有 2 例需要进一步手术。