Prasad N, Ali A, Stanley D
Tameside NHS Trust, Fountain Street, Ashton-U-Lyne Lancashire OL6 9RW, UK.
Sheffield Teaching Hospital NHS Trust, Herries Road, Sheffield S5 7AU, UK.
Bone Joint J. 2016 Mar;98-B(3):381-6. doi: 10.1302/0301-620X.98B3.35508.
We review our experience of Coonrad-Morrey total elbow arthroplasty (TEA) for fractures of the distal humerus in non-rheumatoid patients with a minimum of ten years follow-up.
TEA through a triceps splitting approach was peformed in 37 non-rheumatoid patients for a fracture of the distal humerus between 1996 and 2004. One patient could not be traced and 17 had died before the tenth anniversary of their surgery. This left 19 patients with a minimum follow-up of ten years to form the study group. Of these, 13 patients were alive at the time of final review. The other six had died, but after the tenth anniversary of their elbow arthroplasty. Their clinical and radiological data were included in the study.
The mean follow-up of the 19 patients was 156 months (120 to 210). Two patients in the study group had undergone revision. One further patient had undergone a two-stage revision for infection but died before ten-year follow-up. Six other patients in the study group had evidence of loosening or wear of their bushings. Two were clinically symptomatic and were offered revision surgery. Male patients showed higher incidence of loosening and wear. Survivorship, with revision and definite loosening as end-points, was 89.5% at ten years in those patients followed for a minimum of ten years and 86% in the whole group of 36 patients.
This study shows that only 53% of non-rheumatoid patients who undergo TEA for a fracture of the distal humerus survive to the tenth anniversary of their index procedure. For those that survive, TEA provides acceptable outcomes in terms of function and implant survival.
The surgeons undertaking these procedures should be aware of the long-term revision rates and also the gender difference in the rates of loosening.
我们回顾了在非类风湿性患者中应用Coonrad-Morrey全肘关节置换术（TEA）治疗肱骨远端骨折并进行至少十年随访的经验。
1996年至2004年间，37例非类风湿性肱骨远端骨折患者采用经三头肌劈开入路进行了TEA。1例患者失访，17例在手术十周年前死亡。这使得19例患者至少随访十年，构成研究组。其中，13例患者在最后一次复查时仍存活。另外6例已死亡，但在肘关节置换术后十年之后。他们的临床和放射学数据被纳入研究。
19例患者的平均随访时间为156个月（120至210个月）。研究组中有2例患者接受了翻修手术。另有1例患者因感染接受了两阶段翻修，但在十年随访前死亡。研究组中的其他6例患者有衬套松动或磨损的迹象。2例有临床症状，接受了翻修手术。男性患者松动和磨损的发生率更高。以翻修和明确松动为终点，在至少随访十年的患者中，十年生存率为89.5%，在36例患者的整个组中为86%。
本研究表明，因肱骨远端骨折接受TEA的非类风湿性患者中，只有53%存活至初次手术十周年。对于存活的患者，TEA在功能和植入物存活方面提供了可接受的结果。
进行这些手术的外科医生应了解长期翻修率以及松动率的性别差异。
