Bellato Enrico, O'Driscoll Shawn W
Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN, USA; Department of Orthopedics and Traumatology, University of Turin Medical School, Turin, Italy.
Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN, USA.
J Shoulder Elbow Surg. 2017 Mar;26(3):382-388. doi: 10.1016/j.jse.2016.09.039. Epub 2017 Jan 11.
Persistent elbow instability associated with coronoid deficiency is a difficult condition to treat. Several surgical techniques have been described for coronoid reconstruction, but the resulting outcomes have been unpredictable. We hypothesized that a coronoid prosthesis could restore elbow stability.
A nonanatomically shaped metallic coronoid prosthesis was custom designed for each of 3 patients. Each had a chronic fracture-subluxation with persistent instability, deficiencies of the coronoid, and compromise of the radial head. Each patient had undergone 2 to 4 prior failed operations.
At a mean follow-up of 11 years (range, 10-12), 2 of the 3 patients were completely pain free; the third had a visual analog scale pain score not greater than 3/10. All 3 maintained a stable joint, although a functional range of motion was not able to be maintained in any. Two patients rated themselves "improved" and 1 patient rated himself "almost normal" on the Summary Outcome Determination scale. All radiographic follow-up showed the coronoid prosthesis in proper position without loosening.
Prosthetic replacement of the coronoid appears successful in restoring stability in chronically unstable elbows with coronoid deficiency.
与冠状突缺损相关的持续性肘关节不稳定是一种难以治疗的病症。已经描述了几种用于冠状突重建的手术技术，但结果难以预测。我们推测冠状突假体可以恢复肘关节稳定性。
为3例患者分别定制设计了非解剖形状的金属冠状突假体。每例患者均有慢性骨折半脱位伴持续性不稳定、冠状突缺损及桡骨头受损。每例患者此前均接受过2至4次手术，但均失败。
平均随访11年（范围10 - 12年），3例患者中有2例完全无痛；第3例患者视觉模拟评分疼痛不超过3/10。3例患者关节均保持稳定，尽管均未能维持功能活动范围。在总结结果判定量表上，2例患者自评“改善”，1例患者自评“几乎正常”。所有影像学随访显示冠状突假体位置合适，无松动。
对于伴有冠状突缺损的慢性不稳定肘关节，冠状突假体置换在恢复稳定性方面似乎是成功的。
