Toulemonde Julien, Ancelin David, Azoulay Vadim, Bonnevialle Nicolas, Rongières Michel, Mansat Pierre
Département d'Orthopédie et Traumatologie - Urgences Mains, Hôpital Pierre-Paul RIQUET, Hôpital Universitaire de Toulouse, Place du Dr Baylac, 31059, Toulouse Cedex, France.
Int Orthop. 2016 Jan;40(1):73-80. doi: 10.1007/s00264-015-3008-z. Epub 2015 Oct 5.
The complication rate after total elbow arthroplasties is higher than for other arthroplasties.
The purpose of this study was to evaluate the complications and revision rate after 100 semi-constrained total elbow arthroplasties from various types of aetiologies performed in our university hospital.
One hundred linked semiconstrained total elbow arthroplasties were performed and were reviewed with 24-months minimum follow-up. Indications were rheumatoid arthritis (45), trauma (33), revisions (16) and others (6).
At five years average follow-up (range, 2-11), the complication rate was 37 %. Most frequent complications were ulnar nerve involvement (9 %) and triceps insufficiency (7 %). Five implants were aseptically loosed. The infection rate was 4 % with loosening of the implant in two. Four fractures were observed, including three at the ulna and one at the humerus proximal or distal to the stem. The radial nerve was injured in two cases. Failure of the locking system of the prosthesis was noted in one case and a fracture of the ulnar component was found in another patient. A revision surgery was performed in 13 cases (13 %). At follow-up 94 prostheses were still in place and the survival rate was 98 % at five years and 86 % at ten years.
Total elbow arthroplasty remains a difficult procedure with sometimes a high rate of complications necessitating revision procedures. Selection of the patients, a rigorous surgical technique, and a systematic follow-up are prerequisite to limit this incidence.
TYPE OF STUDY/LEVEL OF EVIDENCE: Therapeutic IV.
全肘关节置换术后的并发症发生率高于其他关节置换术。
本研究的目的是评估在我们大学医院进行的100例各种病因的半限制型全肘关节置换术后的并发症和翻修率。
实施了100例相关的半限制型全肘关节置换术，并进行了至少24个月的随访。手术指征包括类风湿性关节炎（45例）、创伤（33例）、翻修手术（16例）和其他（6例）。
平均随访五年（范围2 - 11年），并发症发生率为37%。最常见的并发症是尺神经受累（9%）和肱三头肌功能不全（7%）。5例植入物发生无菌性松动。感染率为4%，其中2例伴有植入物松动。观察到4例骨折，包括3例尺骨骨折和1例肱骨假体柄近端或远端骨折。2例桡神经损伤。1例发现假体锁定系统故障，另1例患者尺骨部件骨折。13例（13%）进行了翻修手术。随访时94例假体仍在位，五年生存率为98%，十年生存率为86%。
全肘关节置换术仍然是一项困难的手术，有时并发症发生率较高，需要进行翻修手术。选择合适的患者、严谨的手术技术和系统的随访是限制这种发生率的前提条件。
研究类型/证据水平：治疗性IV级。
