Kaufmann Robert A, D'Auria Jennifer L, Schneppendahl Johannes
Department of Orthopaedic Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA.
Department of Orthopaedic Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA.
J Hand Surg Am. 2019 Aug;44(8):687-692. doi: 10.1016/j.jhsa.2018.11.020. Epub 2019 Feb 13.
Total elbow arthroplasty (TEA) has lower revision-free survivorship than other major joint replacement. Despite this, elbow replacement has remained popular. Surgical technique for TEA destabilizes the elbow by removing the medial and lateral collateral ligaments and, frequently, the radiocapitellar articulation. Current semiconstrained implants aim to allow for physiological varus and valgus motion by employing a sloppy hinge; however, over time, these designs fail owing to nonanatomic force transmission. Nonanatomic force transmission results from ligament release, force transmission primarily to the humeral and ulnar shafts, and radial head resection. These altered biomechanics may be the source of complications seen in semiconstrained arthroplasty. These complications perpetuate the cycle of failure and ultimately have poor salvage options.
全肘关节置换术（TEA）的无翻修生存率低于其他主要关节置换术。尽管如此，肘关节置换术仍然很受欢迎。TEA的手术技术通过切除内侧和外侧副韧带以及通常的桡骨头关节来破坏肘关节的稳定性。目前的半限制型植入物旨在通过采用宽松的铰链来允许生理性的内翻和外翻运动；然而，随着时间的推移，这些设计由于非解剖学的力传递而失效。非解剖学的力传递源于韧带松解、力主要传递至肱骨干和尺骨干以及桡骨头切除。这些改变的生物力学可能是半限制型关节成形术中所见并发症的根源。这些并发症使失败的循环持续存在，最终的挽救选择也很差。
