Rhee Yong Girl, Cho Nam Su, Park Jung Gwan, Song Jong Hoon
Shoulder & Elbow Clinic, Department of Orthopaedic Surgery, College of Medicine, Kyung Hee University, Seoul, South Korea.
Shoulder & Elbow Clinic, Department of Orthopaedic Surgery, College of Medicine, Kyung Hee University, Seoul, South Korea.
J Shoulder Elbow Surg. 2016 Jan;25(1):105-11. doi: 10.1016/j.jse.2015.08.045. Epub 2015 Oct 23.
Periprosthetic infection after total elbow arthroplasty (TEA) is a serious complication that has no clearly defined treatment. The purpose of this study was to report the outcomes of resection arthroplasty for treatment of infection after TEA and the factors influencing the result.
Ten elbows (9 patients) underwent resection arthroplasty for treatment of infection after TEA. The mean follow-up duration was 52.4 (range, 24-113) months. According to remnant distal humerus bone stock, we divided the elbows into 3 groups: lateral column, medial column, and both columns.
The average time to resolution of symptoms of clinical infection and normalization of serologic marker levels was 6.8 (range, 5-12) and 68.5 (range, 20-148) days after resection. The mean Mayo Elbow Performance Score and Disabilities of the Arm, Shoulder, and Hand score changed from 50.0 (range, 40-60) and 46.5 (range, 29-67) preoperatively to 73.5 (range, 55-85) and 53.0 (range, 33-65) at the last follow-up (P < .001 and P < .001, respectively). Although it was insignificant, the both-columns group showed better functional outcomes (Mayo Elbow Performance Score, 80.0; Disabilities of the Arm, Shoulder, and Hand score, 43.7) than the lateral (74.0, 54.6) or medial (62.5, 63.0) column group. The mean satisfaction score was 70.0 (range, 50-80) at the final follow-up. Only 1 case required additional operations to treat recurrent infection. There were no refractory infections, fractures, or permanent nerve lesions.
Resection arthroplasty can be an acceptable salvage treatment for infection after TEA for low-demand patients. To achieve success, both columns of the distal humerus must be preserved at implant removal.
全肘关节置换术（TEA）后假体周围感染是一种严重并发症，尚无明确的治疗方法。本研究的目的是报告切除关节成形术治疗TEA后感染的结果及影响结果的因素。
10例肘关节（9例患者）接受了切除关节成形术以治疗TEA后感染。平均随访时间为52.4（范围24 - 113）个月。根据残留的肱骨远端骨量，我们将肘关节分为3组：外侧柱组、内侧柱组和双侧柱组。
切除术后临床感染症状缓解和血清学标志物水平恢复正常的平均时间分别为6.8（范围5 - 12）天和68.5（范围20 - 148）天。末次随访时，平均梅奥肘关节功能评分和上肢、肩部和手部功能障碍评分分别从术前的50.0（范围40 - 60）和46.5（范围29 - 67）变为73.5（范围55 - 85）和53.0（范围33 - 65）（P均 <.001）。虽然差异无统计学意义，但双侧柱组的功能结果（梅奥肘关节功能评分80.0；上肢、肩部和手部功能障碍评分43.7）优于外侧柱组（74.0，54.6）或内侧柱组（62.5，63.0）。末次随访时平均满意度评分为70.0（范围50 - 80）。仅1例患者需要再次手术治疗复发性感染。未出现难治性感染、骨折或永久性神经损伤。
对于需求较低的患者，切除关节成形术可作为TEA后感染的一种可接受的挽救治疗方法。为取得成功，在取出植入物时必须保留肱骨远端的双侧柱。
