Pogliacomi Francesco, Aliani Davide, Cavaciocchi Michele, Corradi Maurizio, Ceccarelli Francesco, Rotini Roberto
Orthopaedic and Traumatologic Department, University of Parma, Parma, Italy.
Orthopaedic and Traumatologic Department, University of Parma, Parma, Italy.
J Shoulder Elbow Surg. 2015 Dec;24(12):1998-2007. doi: 10.1016/j.jse.2015.08.010. Epub 2015 Oct 21.
Total elbow arthroplasties (TEAs) are usually indicated in chronic inflammatory arthropathies. This procedure has also recently been used in complex distal humeral fractures and nonunions in selected patients. This study analyzed the clinical and radiographic outcomes in patients treated for nonunions around the elbow region with a minimum follow-up of 3 years.
Between May 2002 and June 2012, 20 patients affected with distal humeral nonunions were treated with TEA. All patients were assessed clinically using the Mayo Elbow Performance Score and radiographically to evaluate the positioning of the prosthetic components and signs of loosening. Statistical analyses were performed to investigate the presence of clinical and radiographic variables as predictive factors of poor functional outcomes.
The Mayo Elbow Performance Score of the affected arm improved significantly between the preoperative period and follow-up. Results were good or excellent in 90% of the patients even if a high rate of complications (30%) was encountered. The development of complications after surgery and stages II, III, and IV radiolucency, according to the Morrey criteria, were predictive factors of poor outcomes.
According to the satisfactory results observed in this study, TEA could be indicated in selected patients aged older than 70 years with low functional demands and affected with distal humeral nonunions in which obtaining a stable fixation is difficult.
全肘关节置换术（TEAs）通常用于慢性炎症性关节病。该手术最近也被用于特定患者的复杂肱骨远端骨折和骨不连。本研究分析了肘关节周围骨不连患者经治疗后的临床和影像学结果，随访时间至少为3年。
2002年5月至2012年6月期间，20例肱骨远端骨不连患者接受了全肘关节置换术治疗。所有患者均使用Mayo肘关节功能评分进行临床评估，并通过影像学检查评估假体组件的位置和松动迹象。进行统计分析以调查临床和影像学变量作为功能预后不良预测因素的存在情况。
患侧手臂的Mayo肘关节功能评分在术前和随访期间有显著改善。即使遇到较高的并发症发生率（30%），90%的患者结果为良好或优秀。根据Morrey标准，术后并发症的发生以及II、III和IV期透亮线是预后不良的预测因素。
根据本研究观察到的满意结果，对于功能需求较低、年龄大于70岁且难以获得稳定固定的肱骨远端骨不连患者，全肘关节置换术可能是一种选择。
