Department of Anatomical, Histological, Forensic Medicine and Orthopaedics Sciences, "Sapienza" University of Rome - Policlinico Umberto I, Piazzale Aldo Moro 3, Rome, Italy.
Department of Anatomical, Histological, Forensic Medicine and Orthopaedics Sciences, "Sapienza" University of Rome - Policlinico Umberto I, Piazzale Aldo Moro 3, Rome, Italy.
Injury. 2014 Feb;45(2):428-36. doi: 10.1016/j.injury.2013.09.019. Epub 2013 Sep 19.
The outcome of prosthetic elbow surgery is continually evolving. We thoroughly reviewed the literature on this issue to analyse the indications, outcomes and complications of the numerous types of implants currently in use. Radial head replacement is recommended in comminuted fractures of the radial head and in post-traumatic conditions. Medium- and long-term results prove to be satisfactory in the majority of cases, with no evidence to indicate that some prostheses (monopolar vs. bipolar; cemented vs. press-fit) are more effective than others; nonetheless, the bipolar-cemented implant was found to be associated with a lower revision rate than other prostheses. Unicompartmental arthroplasty has recently been used for the treatment of osteoarthritis and rheumatoid arthritis when the lateral compartment is prevalently involved; the results reported to date have been encouraging, although further studies are warranted to confirm the validity of these implants. Total elbow arthroplasty is performed in a range of conditions, including distal humerus fractures in the elderly and elbow arthritis. In the former condition, linked elbow replacement yields excellent results with few complications and a low revision rate. In elbow arthritis, total elbow arthroplasty is indicated when patients suffer from disabling pain, stiffness and/or instability that prevent them from performing daily activities. Unlinked elbow arthroplasty, which is used above all in rheumatoid arthritis, also yields satisfactory results, although the risk of instability persists. The use of linked elbow arthroplasty, which yields similar results but lower revision rates, has consequently increased. Lastly, the results yielded by linked elbow prosthesis in post-traumatic conditions are good, although not quite as good as those obtained in rheumatoid arthritis. Early mechanical failure may occur in younger and more active patients after elbow arthroplasty. However, the careful selection of patients who are prepared to accept functional limitations imposed by elbow implants will enable indications for elbow arthroplasty to be extended to young subjects, particularly when no other therapeutic options are available.
人工肘关节手术的结果在不断发展。我们彻底回顾了这个问题的文献，分析了目前使用的众多植入物的适应证、结果和并发症。在桡骨头粉碎性骨折和创伤后，建议行桡骨头置换术。在大多数情况下，中、长期结果是令人满意的，没有证据表明某些假体（单极与双极；骨水泥与压配）比其他假体更有效；尽管如此，双极骨水泥假体与其他假体相比，翻修率较低。单髁关节置换术最近用于治疗外侧间室受累为主的骨关节炎和类风湿关节炎；迄今为止报告的结果令人鼓舞，尽管需要进一步的研究来证实这些植入物的有效性。全肘关节置换术用于多种情况，包括老年肱骨远端骨折和肘关节炎。在前者的情况下，联合肘置换术的并发症少、翻修率低，效果极好。在肘关节炎中，如果患者因疼痛、僵硬和/或不稳而无法进行日常活动，导致生活质量下降，需要进行全肘关节置换术。全肘人工关节置换术主要用于类风湿关节炎患者，效果也令人满意，但不稳定的风险仍然存在。由于联合肘假体的使用效果相似，但翻修率较低，因此其使用有所增加。最后，在创伤后条件下，联合肘假体的结果良好，但不如类风湿关节炎患者的结果好。在肘关节置换术后，年轻且活跃的患者可能会出现早期机械故障。然而，通过仔细选择愿意接受肘植入物带来的功能限制的患者，将使肘关节置换术的适应证扩展到年轻患者，特别是在没有其他治疗选择的情况下。
