Iwamoto Takuji, Ikegami Hiroyasu, Suzuki Taku, Oki Satoshi, Matsumura Noboru, Nakamura Masaya, Matsumoto Morio, Sato Kazuki
Department of Orthopaedic Surgery, Keio University School of Medicine, Tokyo, Japan.
Department of Orthopaedic Surgery, Toho University, Tokyo, Japan.
Keio J Med. 2018 Jun 25;67(2):19-25. doi: 10.2302/kjm.2017-0007-IR. Epub 2017 Aug 24.
Unlinked total elbow arthroplasty (TEA), which has no mechanical connection between the humeral and ulnar components, has theoretical advantages based on its near-normal elbow kinematics and the preservation of bone stock. Unlinked TEA is appropriate only for patients who have limited bone loss or limited deformity and good ligamentous function. This is because postoperative instability has been a major complication of unlinked prostheses. The concept and goal of unlinked TEA is to share the loading stress on the bone implant interface with the surrounding tissues. Although the loosening rate of unlinked prostheses theoretically should be lower than that of linked prostheses (which have a mechanical connection between the humeral and ulnar components), there is no clear evidence that unlinked TEAs are superior to linked TEAs in this respect. However, we believe that primary TEA should be performed using an unlinked TEA, especially for younger patients, because revision surgery for unlinked TEA results in longer prosthesis survival than revision surgery for linked TEA. Improvement of the design of unlinked prostheses and the introduction of less invasive surgical techniques are required to reduce postoperative instability.
非铰链式全肘关节置换术（TEA），即肱骨和尺骨部件之间没有机械连接，基于其接近正常的肘关节运动学和骨量保留具有理论优势。非铰链式TEA仅适用于骨丢失有限或畸形有限且韧带功能良好的患者。这是因为术后不稳定一直是非铰链式假体的主要并发症。非铰链式TEA的概念和目标是与周围组织分担骨植入物界面上的负荷应力。尽管理论上非铰链式假体的松动率应低于铰链式假体（肱骨和尺骨部件之间有机械连接），但没有明确证据表明在这方面非铰链式TEA优于铰链式TEA。然而，我们认为初次TEA应采用非铰链式TEA进行，尤其是对于年轻患者，因为非铰链式TEA的翻修手术比铰链式TEA的翻修手术假体生存率更高。需要改进非铰链式假体的设计并引入侵入性较小的手术技术以减少术后不稳定。
