Carità E, Donadelli A, Cugola L, Perazzini P
Clinica San Francesco, Via Monte Ortigara 20, 37120, Verona, Italy.
Musculoskelet Surg. 2017 Dec;101(Suppl 2):197-204. doi: 10.1007/s12306-017-0492-x. Epub 2017 Aug 14.
BACKGROUND/PURPOSE: Radial head replacement is frequently used in treatment of radial head fractures or sequela. Impossibility to restore a correct anatomy, acute elbow traumatic instability and failure of osteosynthesis hardware are the most common indications. The authors describe their case studies and results on the implantation of various radial head prostheses.
Between June 2005 and June 2016, 28 radial head prostheses were implanted in the same number of patients with an average follow-up of 49 months (6-104). Indications for implantation were: Mason type III and IV radial head fractures and post-traumatic arthritis due to failure of previous treatments. Monopolar prostheses were used and were press-fit implanted via Kaplan's lateral access and Kocher's anconeus approach to the humeroradial joint. At the follow-up, assessments were made of the pain, according to the visual analogic scale, range of motion (ROM), stability and functionality according to the Mayo Elbow Performance Score, presence of osteolysis and mobilization during radiography tests, personal satisfaction of the patients, Disabilities of the Arm, Shoulder and Hand and Patient-Rated Wrist Evaluation outcomes measurements.
At the follow-up, we recorded an average level of pain of 1.8 in patients under acute treatments for radial head fractures and a marked reduction in the remaining cases from 6.7 to 2.1. ROM was found on average to be 107° of flexion-extension and 159° of pronosupination. Personal satisfaction was good-excellent in 23 cases. There was no case of infection; removal of the implant was necessary in three cases due to mobilization of the stem and oversized implants. In six cases, bone resorption was seen at the level of the prosthetic collar and it was in all cases asymptomatic.
The results of this study suggest that the use of prostheses, if well positioned, is a valid solution in the treatment of secondary arthritis and fractures of the radial head with poor prognosis, with good results in the reduction of pain, recovery of movement and improved quality of life.
背景/目的：桡骨头置换常用于治疗桡骨头骨折或后遗症。无法恢复正确的解剖结构、急性肘关节创伤性不稳定以及骨合成硬件的失败是最常见的适应症。作者描述了他们在植入各种桡骨头假体方面的病例研究和结果。
2005年6月至2016年6月期间，在相同数量的患者中植入了28个桡骨头假体，平均随访49个月（6 - 104个月）。植入适应症为：梅森III型和IV型桡骨头骨折以及既往治疗失败导致的创伤后关节炎。使用单极假体，通过卡普兰外侧入路和科赫尔肘肌入路将其压配植入肱桡关节。随访时，根据视觉模拟量表评估疼痛程度，根据梅奥肘关节功能评分评估活动范围（ROM）、稳定性和功能，通过X线检查评估骨溶解情况和活动度，评估患者的个人满意度、上肢、肩部和手部功能障碍以及患者自评腕关节评估结果测量。
随访时，我们记录到桡骨头骨折急性治疗患者的平均疼痛程度为1.8，其余病例的疼痛程度从6.7显著降低至2.1。发现ROM平均为屈伸107°，旋前旋后159°。23例患者的个人满意度为良好至优秀。无感染病例；3例因假体柄松动和假体过大需要取出植入物。6例在假体柄处可见骨吸收，所有病例均无症状。
本研究结果表明，假体使用得当的话，是治疗预后不良的桡骨头继发性关节炎和骨折的有效解决方案，在减轻疼痛、恢复活动和改善生活质量方面效果良好。
