Kumar Suresh, Mahanta Sunayan
Department of Orthopedics, Maharishi Valmiki Hospital, Pooth Khurd, Delhi, India.
Indian J Orthop. 2013 Nov;47(6):608-14. doi: 10.4103/0019-5413.121592.
Primary total elbow arthroplasty (TEA) is a challenging procedure for orthopedic surgeons. It is not performed as frequently as compared to hip or knee arthroplasty. The elbow is a nonweight-bearing joint; however, static loading can create forces up to three times the body weight and dynamic loading up to six times. For elderly patients with deformity and ankylosis of the elbow due to posttraumatic arthritis or rheumatoid arthritis or comminuted fracture distal humerus, arthroplasty is one of the option. The aim of this study is to analyze the role of primary total elbow arthroplasty in cases of crippling deformity of elbow.
We analyzed 11 cases of TEA, between December 2002 and September 2012. There were 8 females and 3 males. The average age was 40 years (range 30-69 years). The indications for TEA were rheumatoid arthritis, comminuted fracture distal humerus with intraarticular extension, and posttraumatic bony ankylosis of elbow joint. The Baksi sloppy (semi constrained) hinge elbow prosthesis was used. Clinico-radiological followup was done at 1 month, 3 months, 6 months, 1 year, and then yearly basis.
In the present study, average supination was 70° (range 60-80°) and average pronation was 70° (range 60-80°). Average flexion was 135° (range 130-135°). However, in 5 cases, there was loss of 15 to 35° (average 25°) of extension (45°) out of 11 cases. The mean Mayo elbow performance score was 95.4 points (range 70-100). Arm length discrepancy was only in four patients which was 36% out of 11 cases. Clinico-radiologically all the elbows were stable except in one case and no immediate postoperative complication was noted. Radiolucency or loosening of ulnar stem was seen in 2 cases (18%) out of 11 cases, in 1 case it was noted after 5 years and in another after 10 years. In second case, revision arthroplasty was done, in which only ulnar hinge section, hinge screw and lock screw with hexagonal head were replaced.
Elbow arthroplasty remains a valuable option for deformed and ankylosed elbows especially in the demanding patients with crippling deformity of the elbow.
对于骨科医生而言，初次全肘关节置换术（TEA）是一项具有挑战性的手术。与髋关节或膝关节置换术相比，其施行频率较低。肘关节是一个非负重关节；然而，静态负荷可产生高达体重三倍的力量，动态负荷则可高达体重六倍。对于因创伤后关节炎、类风湿关节炎或肱骨远端粉碎性骨折导致肘关节畸形和强直的老年患者，关节置换术是一种选择。本研究的目的是分析初次全肘关节置换术在肘关节严重畸形病例中的作用。
我们分析了2002年12月至2012年9月期间的11例全肘关节置换术病例。其中女性8例，男性3例。平均年龄为40岁（范围30 - 69岁）。全肘关节置换术的适应证为类风湿关节炎、肱骨远端粉碎性骨折伴关节内延伸以及创伤后肘关节骨性强直。使用了Baksi宽松型（半限制）铰链式肘关节假体。在术后1个月、3个月、6个月、1年进行临床放射学随访，之后每年随访一次。
在本研究中，平均旋后角度为70°（范围60 - 80°），平均旋前角度为70°（范围60 - 80°）。平均屈曲角度为135°（范围130 - 135°）。然而，在11例病例中有5例出现了伸展功能丧失15至35°（平均25°）（正常伸展角度为45°）。Mayo肘关节功能评分平均为95.4分（范围70 - 100）。11例中有4例存在臂长差异，占36%。临床放射学检查显示，除1例病例外所有肘关节均稳定，且未发现术后即刻并发症。11例中有2例（18%）出现尺骨柄透光或松动，1例在5年后发现，另1例在10年后发现。对于第二例，进行了翻修关节置换术，仅更换了尺骨铰链部分、铰链螺钉和六角头锁定螺钉。
肘关节置换术对于畸形和强直的肘关节仍然是一种有价值的选择，特别是对于有严重肘关节畸形的高要求患者。
