Sivakumar R, SomaSheker V, Shingi Prahalad Kumar, Vinoth T, Chidambaram M
Department of Orthopaedics, Preethi Institute of Orthopaedics and Research, Preethi Hospitals (Pvt) Limited, Madurai, Tamil Nadu, India.
J Orthop Case Rep. 2016 Sep-Oct;6(4):49-52. doi: 10.13107/jocr.2250-0685.566.
The elbow is a complex joint involving many articulations and complex biomechanics come into play. Elbow motion is crucial to upper limb movement that loss of 50% of elbow function equals to loss of 80% of upper extremity global function. Restoring movement and stability is challenging to the surgeon while treating a stiff elbow. Unlike other arthroplasties of hip and knee, total elbow arthroplasty (TEA) may not be a primary treatment. Interpositional arthroplasty (IPA) can be considered a viable option in posttraumatic arthritis of elbow in young patients.
We report two cases of interpositional arthroplasties done in young patients secondary to posttraumatic event. The first case is 22-year-old female with a history of stiff elbow following a posttraumatic event 3 years back and the second case is 24-year-old male laborer with stiff elbow following trauma more the 10 years back for which he took native treatment. In both the cases through posterior approach to the elbow, we did osteolysis and prepared fascia lata grafts are interpositioned over the recreated articular surfaces. Both the patients in the follow-up have a good range of motion, stability and are satisfied.
IPA is a good treatment option in young patients with posttraumatic arthritis. Elbow instability, fascia rupture, thigh pain, and hernia are the problems of IPA. IPA to TEA transition is possible.
肘关节是一个复杂的关节，涉及多个关节面，复杂的生物力学机制也在其中发挥作用。肘关节的活动对于上肢运动至关重要，肘关节功能丧失50%相当于上肢整体功能丧失80%。对于治疗僵硬的肘关节，恢复其活动度和稳定性对外科医生来说具有挑战性。与髋、膝关节的其他关节成形术不同，全肘关节置换术（TEA）可能并非首选治疗方法。对于年轻患者创伤后关节炎，间置关节成形术（IPA）可被视为一种可行的选择。
我们报告两例年轻患者因创伤后事件行间置关节成形术的病例。第一例是一名22岁女性，3年前创伤后出现肘关节僵硬；第二例是一名24岁男性劳动者，10多年前创伤后出现肘关节僵硬，曾接受保守治疗。在这两例手术中，我们均通过肘关节后入路进行骨溶解，并将制备好的阔筋膜移植片置于重建的关节面上。随访中，两名患者均有良好的活动范围、稳定性，且对治疗效果满意。
对于年轻创伤后关节炎患者，IPA是一种较好的治疗选择。肘关节不稳定、筋膜破裂、大腿疼痛和疝气是IPA存在的问题。IPA向TEA的转换是可行的。
