Erşen Ali, Demirhan Mehmet, Atalar Ata Can, Salduz Ahmet, Tunalı Onur
Istanbul University, Istanbul Faculty of Medicine, Department of Orthopedics and Traumatology, Istanbul, Turkey.
Koç University, School of Medicine, Department of Orthopedics and Traumatology, Istanbul, Turkey.
Acta Orthop Traumatol Turc. 2014;48(5):558-62. doi: 10.3944/AOTT.2014.14.0131.
The aim of this study was to evaluate the long-term radiological and functional results of distraction interposition arthroplasty using an Achilles tendon allograft.
The study included 5 patients (3 females and 2 males; mean age: 31 years, range: 25 to 41 years) who underwent distraction interposition arthroplasty for stiff elbow and arthrosis due to intrinsic factors between 2001 and 2010. Interposition with fresh-frozen Achilles allograft and collateral ligament reconstruction were performed in all patients. Mean follow-up period was 87.6 (range: 40 to 131) months. Mean distraction time with an external fixator was 7 (range: 6 to 8) weeks. Elbow motion was allowed in the first postoperative day in all patients. Radiological evaluation was performed pre- and postoperatively. Elbow ROM, and the Mayo Elbow Performance Score (MEPS) and DASH scores were recorded for functional evaluation.
Mean preoperative flexion-extension range was 24° (range: 0° to 80°) and mean supination-pronation range was 15°. Two patients had elbow ankylosis in 90° and 60° of flexion at the preoperative examination. Mean postoperative flexion-extension range increased significantly to 81° (range: 50° to 110°) (p<0.05). Mean preoperative DASH score improved from 75.3 (range: 53 to 89) to 18.9 (range: 6.7 to 45.8) postoperatively (p<0.05). Mean postoperative MEPS were poor (mean: 25, range: 20 to 35) while postoperative MEPS were good (mean: 71, range: 70 to 75) in 4 patients and fair in 1 (p<0.05). No patient experienced elbow instability at the final follow-up and none required revision.
Distraction interposition arthroplasty is a salvage procedure which appears to have good long-term functional results, especially in patients in which elbow arthroplasty is not suitable. The use of Achilles allograft for interposition can protect the joint space in the long-term.
本研究旨在评估使用跟腱同种异体移植物进行撑开植入关节成形术的长期影像学和功能结果。
本研究纳入了5例患者（3例女性和2例男性；平均年龄：31岁，范围：25至41岁），这些患者在2001年至2010年间因内在因素导致肘关节僵硬和关节炎而接受了撑开植入关节成形术。所有患者均进行了新鲜冷冻跟腱同种异体移植物植入和侧副韧带重建。平均随访时间为87.6（范围：40至131）个月。使用外固定器的平均撑开时间为7（范围：6至8）周。所有患者术后第一天即可进行肘关节活动。术前和术后均进行影像学评估。记录肘关节活动度、梅奥肘关节功能评分（MEPS）和DASH评分以进行功能评估。
术前平均屈伸范围为24°（范围：0°至80°），平均旋前旋后范围为15°。术前检查时，2例患者肘关节分别在90°和60°屈曲位强直。术后平均屈伸范围显著增加至81°（范围：50°至110°）（p<0.05）。术前平均DASH评分从75.3（范围：53至89）术后改善至18.9（范围：6.7至45.8）（p<0.05）。术后平均MEPS较差（平均：25，范围：20至35），而4例患者术后MEPS良好（平均：71，范围：70至75），1例患者一般（p<0.05）。末次随访时无患者出现肘关节不稳定，也无患者需要翻修。
撑开植入关节成形术是一种挽救性手术，似乎具有良好的长期功能结果，尤其是在不适合进行肘关节置换术的患者中。使用跟腱同种异体移植物进行植入可长期保护关节间隙。
