Kachooei Amir Reza, Claessen Femke M A P, Chase Samantha M, Verheij Kirsten K J, van Dijk C Niek, Ring David
Orthopedic Research Center, Mashhad University of Medical Sciences, Mashhad, Iran; Hand and Upper Extremity Service, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA.
Hand and Upper Extremity Service, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA.
Injury. 2016 Jun;47(6):1253-7. doi: 10.1016/j.injury.2016.02.023. Epub 2016 Mar 3.
This study tests the hypothesis that there are no factors associated with removal or revision of a radial head prosthesis. A secondary analysis addressed the time to removal or revision.
We reviewed the database of two large hospitals from 2000 to 2014 and identified 278 patients that had radial head replacement after an acute fracture or fracture dislocation of the elbow: 19 had removal and 3 had revision of the radial head implant within the study period. Explanatory variables including demographics, the type of injury, prosthesis type, surgeon, medical centre, and associated injuries were evaluated. Survival analysis using Kaplan-Meier curves evaluated time to removal/revision.
After adjustment for potential confounders using Cox regression multivariable analysis, hospital was the only factor independently associated with removal or revision (Hazard ratio=2.4, Confidence interval: 1.03-5.8, P value=0.043). The highest proportion of removal/revision was during the first year after implantation and decreased by half each year over the second to fourth years. The most common reason for removal of the prosthesis was to facilitate removal of heterotopic ossification (the majority with proximal radioulnar synostosis) rather than technical error or problems with the prostheses.
These findings suggest that the decision to remove a radial head prosthesis may depend more on surgeon or hospital preferences than on objective problems with the prosthesis. Until clarified by additional study, removal of a prosthesis should not be considered an objective outcome in research. In addition, patients offered removal of a radial head prosthesis, might get the opinion of more than one surgeon at more than one hospital before deciding whether or not to proceed.
Level III Prognostic.
本研究检验了不存在与桡骨头假体取出或翻修相关因素的假设。二次分析探讨了取出或翻修的时间。
我们回顾了两家大型医院2000年至2014年的数据库，确定了278例因肘部急性骨折或骨折脱位后进行桡骨头置换的患者：在研究期间，19例进行了桡骨头假体取出，3例进行了翻修。对包括人口统计学、损伤类型、假体类型、外科医生、医疗中心和相关损伤等解释变量进行了评估。使用Kaplan-Meier曲线进行生存分析，评估取出/翻修时间。
使用Cox回归多变量分析对潜在混杂因素进行调整后，医院是唯一与取出或翻修独立相关的因素（风险比=2.4，置信区间：1.03-5.8，P值=0.043）。取出/翻修的最高比例发生在植入后的第一年，在第二至第四年每年减少一半。取出假体最常见的原因是便于去除异位骨化（大多数伴有近端桡尺关节融合），而非技术失误或假体问题。
这些发现表明，取出桡骨头假体的决定可能更多地取决于外科医生或医院的偏好，而非假体的客观问题。在通过进一步研究明确之前，假体取出不应被视为研究中的客观结果。此外，接受桡骨头假体取出的患者在决定是否进行手术前，可能应在多家医院咨询多位外科医生的意见。
III级预后性。
