Department of Orthopedic Surgery, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA.
Clin Orthop Relat Res. 2014 Jul;472(7):2151-61. doi: 10.1007/s11999-014-3629-3.
Radiocapitellar arthritis and/or proximal radioulnar impingement can be difficult to treat. Interposition of the anconeus muscle has been described in the past as an alternative option in managing arthritis, but there are little published data about relief of pain and restoration of function over the long term in patients treated with this approach.
QUESTIONS/PURPOSES: We sought (1) to determine whether interposition of the anconeus muscle in the radiocapitellar and/or proximal radioulnar joint relieves pain and restores elbow function; and (2) to identify complications and reoperations after anconeus interposition arthroplasty.
Between 1992 and 2012, we surgically treated 39 patients having radiocapitellar arthritis and/or proximal radioulnar impingement with an anconeus interposition arthroplasty. These were performed for situations in which capitellar and/or radial head pathology was deemed not amenable to implant replacement. We had complete followup on 29 of them (74%) at a minimum of 1 year (mean, 10 years; range, 1-20 years). These 29 patients (21 males, eight females) had interposition of the anconeus muscle at the radiocapitellar joint (10 elbows), the proximal radioulnar joint (two elbows), or both (17 elbows). Their mean age at the time of surgery was 39 years (range, 14-58 years). The reasons for the previous determination or the indications included lateral-side elbow symptoms after radial head resection (eight elbows), failed internal fixation of radial head fracture (two elbows), failed radial head replacement with or without capitellar replacement (four elbows), osteoarthritis and Essex-Lopresti injury (six elbows), failed internal fixation of distal humeral fracture involving the capitellum (two elbows), posttraumatic osteoarthritis involving the lateral compartment (one elbow), lateral compartment osteoarthritis associated with chondropathies (three elbows), and primary osteoarthritis affecting the lateral compartment (three elbows). Patient-reported outcome tools included the quick-Disabilities of the Arm, Shoulder and Hand (quick-DASH) and the Mayo Elbow Performance Score (MEPS); we also performed a chart review for complications and reoperations.
During the followup duration, the mean MEPS was significantly improved from (mean ± SD) 64 ± 17 points before surgery to 82 ± 14 points after surgery (p < 0.001) with 21 elbows (72%) graded as excellent or good at most recent followup. The mean quick-DASH score was 24 ± 17 points (n = 25) at latest evaluation. Two patients (7%) had perioperative complications, including wound dehiscence (one elbow) and transient posterior interosseous nerve palsy (one elbow). Seven patients (24%) underwent additional surgery.
Anconeus arthroplasty provides a reasonable surgical alternative in the armamentarium of procedures to address pathology at the radiocapitellar and/or proximal radioulnar joint. This procedure is especially attractive when other alternatives such as radial head replacement may be problematic secondary to capitellar erosion or marked proximal radius bone loss.
Level IV, therapeutic study. See Guidelines for Authors for a complete description of levels of evidence.
放射状头关节炎和/或近端桡尺关节撞击症较难治疗。过去曾描述过将肱三头肌的肌腱骨膜瓣插入桡尺骨近端关节和/或桡骨头下关节作为一种替代方法，但是对于接受这种方法治疗的患者，其长期缓解疼痛和恢复功能的效果，相关数据发表的较少。
问题/目的：我们旨在：（1）确定肱三头肌肌腱骨膜瓣插入桡尺骨近端关节和/或桡骨头下关节是否可以缓解疼痛和恢复肘部功能；（2）确定肱三头肌肌腱骨膜瓣插入桡尺骨近端关节和/或桡骨头下关节后的并发症和再次手术情况。
1992 年至 2012 年，我们对 39 例放射状头关节炎和/或近端桡尺关节撞击症患者采用肱三头肌肌腱骨膜瓣插入桡尺骨近端关节和/或桡骨头下关节进行手术治疗。这些患者的桡骨头和/或头状骨病变被认为不适合进行植入物置换。我们对其中 29 例（74%）至少随访 1 年（平均 10 年；范围 1-20 年）。这 29 例患者（21 例男性，8 例女性）中，10 例（10 肘）接受了肱三头肌肌腱骨膜瓣插入桡尺骨近端关节，2 例（2 肘）接受了肱三头肌肌腱骨膜瓣插入桡骨头下关节，17 例（17 肘）同时接受了肱三头肌肌腱骨膜瓣插入桡尺骨近端关节和桡骨头下关节。手术时患者的平均年龄为 39 岁（范围 14-58 岁）。之前决定进行手术或有手术指征的原因包括：桡骨头切除术后出现外侧肘部症状（8 肘）、桡骨头骨折内固定失败（2 肘）、桡骨头置换和/或头状骨置换失败（4 肘）、骨关节炎和 Essex-Lopresti 损伤（6 肘）、涉及头状骨的肱骨远端骨折内固定失败（2 肘）、创伤后外侧间室骨关节炎（1 肘）、伴有软骨病的外侧间室骨关节炎（3 肘）和影响外侧间室的原发性骨关节炎（3 肘）。患者报告的结果评估工具包括快速残疾的手臂、肩和手（Quick-DASH）和 Mayo 肘部功能评分（MEPS）；我们还进行了并发症和再次手术的图表审查。
在随访期间，MEPS 平均从术前（平均±标准差，64±17 分）显著改善到术后（82±14 分，p<0.001），29 肘（72%）在最近随访时被评为优秀或良好。最新评估时的 Quick-DASH 平均得分为 24±17 分（n=25）。2 例患者（7%）发生围手术期并发症，包括伤口裂开（1 肘）和短暂的后骨间神经麻痹（1 肘）。7 例患者（24%）接受了进一步的手术。
当其他替代方法（如桡骨头置换）由于头状骨侵蚀或桡骨近端骨丢失明显而可能出现问题时，肱三头肌肌腱骨膜瓣插入桡尺骨近端关节和/或桡骨头下关节是一种合理的手术选择。
IV 级，治疗性研究。有关证据水平的完整描述，请参见作者指南。
