Service de chirurgie plastique et reconstructrice de l'appareil locomoteur, Centre chirurgical Emile-Gallé, CHU de Nancy, 54000 Nancy, France.
Service de Chirurgie orthopédique et traumatologique, CHU Purpan, 31000 Toulouse, France.
Orthop Traumatol Surg Res. 2014 Feb;100(1):113-8. doi: 10.1016/j.otsr.2013.10.012. Epub 2013 Dec 24.
Traumatic sequelae of the elbow are difficult to manage because of bone deformities, changes in joint congruency and bone defects.
Total elbow arthroplasty is a therapeutic option when the joint space has disappeared. Nineteen patients underwent semi-constrained Coonrad-Morrey(®) total elbow arthroplasty in 12 cases for post-traumatic elbow arthritis (group 1) and in seven cases for 7 non-union of the distal humerus (group 2). The mean age at surgery was 60 years old (56 in group 1 and 67 in group 2). The mean delay between the initial trauma and arthroplasty was 16 years (group 1) and 22 months (group 2).
At a mean follow-up of 5.5 years (24-156 months) in group 1, the Quick-DASH score was 34 points with outcomes that were considered to be good to excellent in 75% of the cases according to the Mayo Elbow Performance Score (MEPS). A progressive radiolucency was identified on X-ray in 33% of the cases, and moderate wear of the polyethylene insert in 17%. There were 7 complications (58%) requiring revision in 3 cases (25%). At a mean follow-up of 4.6 years (24-108 months) in group 2, the Quick-DASH score was 39 points with good and excellent results in 86% according to the MEPS. A radiolucency was noted in 28% and moderate wear of the inserts in 14%. There were 2 complications (28%) requiring revision in 1 case (14%).
Semi-constrained total elbow arthroplasties provide recovery of functional range of motion with a stable and pain-free elbow for post-traumatic conditions. The age at surgery is a risk factor for complications. The indication for total elbow arthroplasty in patients under 60 should be carefully considered in relation to alternative treatment options.
Level IV Retrospective study.
肘部创伤后遗症由于骨畸形、关节对位改变和骨缺损而难以处理。
当关节间隙消失时，全肘关节置换是一种治疗选择。19 例患者接受半约束型 Coonrad-Morrey（®）全肘置换术，12 例为创伤后肘关节炎（1 组），7 例为肱骨远端非愈合（2 组）。手术时的平均年龄为 60 岁（1 组 56 岁，2 组 67 岁）。初始创伤与关节置换之间的平均时间间隔为 16 年（1 组）和 22 个月（2 组）。
在 1 组的平均随访 5.5 年（24-156 个月）中，Quick-DASH 评分为 34 分，根据 Mayo 肘功能评分（MEPS），75%的病例结果被认为是良好到优秀。33%的病例在 X 线上发现进行性透亮区，17%的病例聚乙烯插入物中度磨损。有 7 例（58%）并发症需要 3 例（25%）翻修。在 2 组的平均随访 4.6 年（24-108 个月）中，Quick-DASH 评分为 39 分，根据 MEPS，86%的结果为良好和优秀。28%的病例发现透亮区，14%的病例插入物中度磨损。有 2 例（28%）并发症需要 1 例（14%）翻修。
半约束型全肘置换术为创伤后情况提供了功能活动范围的恢复，使肘部稳定无痛。手术时的年龄是并发症的危险因素。对于 60 岁以下的患者，应仔细考虑全肘置换术的适应证，并与替代治疗方案进行比较。
IV 级回顾性研究。
