Kerlan-Jobe Orthopaedic Clinic, a Cedars-Sinai Affiliate at Adventist Health, Los Angeles, CA, USA.
Kerlan-Jobe Orthopaedic Clinic, a Cedars-Sinai Affiliate at Adventist Health, Los Angeles, CA, USA.
J Shoulder Elbow Surg. 2018 Jun;27(6S):S29-S34. doi: 10.1016/j.jse.2018.02.052.
Radiocapitellar pathology after traumatic injury to the elbow can be challenging to treat. The anconeus interposition arthroplasty has been proposed to treat radiocapitellar or proximal radioulnar joint dysfunction and pain, or both. This study evaluated whether radial head excision (native or prosthetic), followed by an anconeus interposition arthroplasty, relieves pain and improves subjective and objective elbow function in patients with post-traumatic radiocapitellar pathology.
A retrospective comparative case series was performed of 50 consecutive patients who underwent a native radial head excision or radial head implant excision, followed by an anconeus interposition arthroplasty. Clinical outcome scores, range of motion, and proximal radius migration were evaluated in patients with at least 2 years of follow-up.
Included were 23 patients (11 native and 12 prosthetic radial heads) with a mean age of 41 years. Average follow-up was 38 months. Overall, significant improvement was obtained in the Disabilities of the Arm, Shoulder and Hand and visual analog scale scores. Range of motion significantly improved from preoperatively to postoperatively. Patients with a native radial head excision scored better on the Single Assessment Numeric Evaluation (76.8 vs. 56.3, P = .037) and obtained significantly more flexion postoperatively (141° vs. 123°, P = .016). Mild wrist pain developed in 3 patients, but no further intervention was required. The overall complication rate was 13%, and 5 patients required reoperation.
Anconeus interposition arthroplasty performed after radial head resection in native and prosthetic groups is a viable adjunct in the operative treatment of patients with post-traumatic radiocapitellar pathology. However, whether anconeus interposition arthroplasty alone produced the favorable clinical results of this study was difficult to determine.
肘部创伤后发生的桡骨头下病变的治疗具有挑战性。已提出尺骨鹰嘴突间关节成形术来治疗桡骨头下或近桡尺关节功能障碍和疼痛，或两者皆治。本研究评估了桡骨头切除（自体或假体）后行尺骨鹰嘴突间关节成形术是否能缓解疼痛并改善创伤后桡骨头下病变患者的主观和客观肘部功能。
对 50 例连续患者进行了回顾性对照病例系列研究，这些患者均行自体桡骨头切除或桡骨头假体切除，随后行尺骨鹰嘴突间关节成形术。对至少随访 2 年的患者进行临床结果评分、活动范围和近侧桡骨迁移评估。
纳入的 23 例患者（11 例自体和 12 例假体桡骨头）的平均年龄为 41 岁。平均随访时间为 38 个月。总体而言，手臂、肩部和手的残疾程度和视觉模拟评分均显著改善。术后活动范围明显改善。行自体桡骨头切除的患者在单评估数字评估（76.8 对 56.3，P = .037）上得分更好，术后获得的屈曲角度明显更大（141°对 123°，P = .016）。3 例患者出现轻度腕部疼痛，但无需进一步干预。总体并发症发生率为 13%，5 例患者需要再次手术。
自体和假体组桡骨头切除后行尺骨鹰嘴突间关节成形术是创伤后桡骨头下病变患者手术治疗的一种可行方法。然而，很难确定是否单独行尺骨鹰嘴突间关节成形术就能产生本研究的良好临床结果。
