Department of Orthopedic Surgery, Rush University Medical Center, Chicago, IL, USA.
Department of Orthopedic Surgery, Rush University Medical Center, Chicago, IL, USA.
J Shoulder Elbow Surg. 2018 Feb;27(2):e38-e44. doi: 10.1016/j.jse.2017.09.015. Epub 2017 Nov 8.
We report the long-term results of a cohort of patients after radial head replacement with a bipolar design and a smooth cementless stem at a mean follow-up of 10.4 years.
Of 17 possible patients from a previous minimum 2-year follow-up study, 16 were available for review. Patients were assessed using clinical and radiographic examination and with standardized outcome measures. Range of motion, stability, and radiographic evaluation of implant loosening and joint degeneration were assessed. Comparisons were performed using the Wilcoxon signed rank test for unequal groups.
The average follow-up was 10.5 years (range, 8.5-12 years). The median visual analog scale was 1 (range, 0-5), Minnesota Elbow Performance Index was 93 (range, 70-100), and the Disabilities of the Arm, Shoulder and Hand was 7.5 (range, 0-53). Range of motion was decreased on the operative side compared with the nonoperative side for flexion/extension (P = .005) and pronation/supination (P = .015). Grip strength was decreased on the affected side (P = .045). No patients had elbow instability. Significant arthritic changes developed in 2 patients at the ulnohumeral joint. The median cantilever quotient was 0.4 (range, 0.30-0.50). Osteolysis in zones 1 to 7 was found in all but 2 patients. The median stem radiolucency was 0.5 mm (range, 0.2-0.9 mm). No reoperations occurred since our previous report. Implant survival in this cohort was 97%.
Bipolar radial head prosthesis with a smooth cementless stem effectively restores elbow stability and function after comminuted radial head fractures with or without concomitant elbow instability. Our study demonstrates excellent long-term implant survival.
我们报告了一组使用双极设计的桡骨小头置换和光滑非骨水泥柄的患者的长期结果，平均随访时间为 10.4 年。
在之前至少 2 年随访研究的 17 例可能患者中，有 16 例可供回顾。通过临床和影像学检查以及标准化的结果测量对患者进行评估。评估了活动范围、稳定性以及假体松动和关节退变的影像学评估。使用非参数 Wilcoxon 符号秩检验进行比较。
平均随访时间为 10.5 年（范围 8.5-12 年）。中位数视觉模拟评分（VAS）为 1（范围 0-5），明尼苏达州肘功能评分（MEPS）为 93（范围 70-100），手臂、肩部和手功能障碍（DASH）为 7.5（范围 0-53）。与非手术侧相比，手术侧的屈伸（P=0.005）和旋前/旋后（P=0.015）活动范围减小。患侧握力下降（P=0.045）。无患者发生肘不稳定。2 例患者发生肱尺关节显著关节炎改变。中位悬臂比为 0.4（范围 0.30-0.50）。除 2 例患者外，所有患者在区域 1 至 7 均发现溶骨性病变。中位柄透亮线为 0.5mm（范围 0.2-0.9mm）。自上次报告以来，未再进行手术。该队列的植入物存活率为 97%。
对于粉碎性桡骨小头骨折，即使伴有或不伴有肘不稳定，双极桡骨小头假体和光滑非骨水泥柄可有效恢复肘稳定性和功能。我们的研究表明长期植入物具有良好的存活率。
