Department of Orthopedic Surgery, Asan Medical Center, College of Medicine, Ulsan University, Seoul, South Korea.
Department of Orthopedic Surgery, Asan Medical Center, College of Medicine, Ulsan University, Seoul, South Korea; Department of Orthopedic Surgery, St. Carolus Hospital, Jakarta, Indonesia.
Arthroscopy. 2019 Apr;35(4):1083-1089. doi: 10.1016/j.arthro.2018.11.057. Epub 2019 Mar 11.
To compare clinical and radiologic outcomes following open (OPEN) and arthroscopic (ARTHRO) osteocapsular arthroplasty for primary elbow osteoarthritis.
Patients treated with osteocapsular arthroplasty between January 2010 and December 2015 were divided into OPEN and ARTHRO groups. OPEN was performed from January 2010 to October 2012, and ARTHRO from November 2012 to December 2015. OPEN and ARTHRO were performed in 35 and 52 elbows, respectively. Clinical outcome was measured using range of motion (ROM) arc, functional score (Mayo Elbow Performance Score [MEPS]), and pain score (visual analog scale [VAS]). Conventional radiography was used for outcome analysis. Outcomes were analyzed according to ulnohumeral joint (UHJ) narrowing using the computed tomography-based modified Broberg and Morrey classification.
Mean follow-up time was 36.6 ± 14.4 (24-89) and 35.4 ± 14.2 (24-83) months following OPEN and ARTHRO, respectively. Average ages were 50.0 ± 7.0 (40-63) and 52.4+10.4 (41-75) years in OPEN and ARTHRO groups, respectively. Overall scores for ROM (preoperative to final follow-up: 65.5° ± 22.8 to 112.0° ± 50.9, P < .01), MEPS (42.9 ± 13.7 to 73.7 ± 16.6, P < .01), and VAS (6.6 ± 1.3 to 4.0 ± 2.3, P < .01) were improved. Preoperative ROM improved from 64.0° ± 23.3 to 118.0° ± 17.8 following OPEN and 66.5° ± 22.6 to 108.0° ± 24.0 following ARTHRO. Preoperative MEPS improved from 40.7 ± 15.6 to 73.6 ± 16.7 following OPEN and 44.3 ± 12.2 to 73.8 ± 16.7 following ARTHRO. Preoperative VAS improved from 6.9 ± 1.2 to 3.9 ± 2.6 following OPEN and 6.4 ± 1.3 to 4.1 ± 2.0 following arthro. In both groups, the last follow-up VAS score and MEPS were worse in the narrowing group (UHJ <2 mm, grades 2 and 3) than in the intact group (UHJ >2 mm, grade 1) (P < .01).
Arthroscopic osteocapsular arthroplasty is comparable to the OPEN procedure in managing primary osteoarthritis of the elbow; however, the OPEN procedure shows the better outcome in improvement of flexion limitation. Neither procedures can guarantee an excellent outcome in the patients with severe UHJ narrowing.
Level III, retrospective comparative trial.
比较原发性肘关节炎行切开（OPEN）和关节镜（ARTHRO）下骨囊成形术的临床和影像学结果。
将 2010 年 1 月至 2015 年 12 月接受骨囊成形术治疗的患者分为 OPEN 和 ARTHRO 两组。OPEN 组于 2010 年 1 月至 2012 年 10 月进行手术，ARTHRO 组于 2012 年 11 月至 2015 年 12 月进行手术。OPEN 和 ARTHRO 分别在 35 个和 52 个肘部进行。使用运动范围（ROM）弧、功能评分（Mayo 肘部表现评分[MEPS]）和疼痛评分（视觉模拟评分[VAS]）来衡量临床结果。常规 X 线用于结果分析。根据基于 CT 的 Broberg 和 Morrey 改良分类法，使用 UHJ 狭窄情况对结果进行分析。
OPEN 和 ARTHRO 组的平均随访时间分别为 36.6 ± 14.4（24-89）和 35.4 ± 14.2（24-83）个月。OPEN 和 ARTHRO 组的平均年龄分别为 50.0 ± 7.0（40-63）和 52.4+10.4（41-75）岁。ROM（术前至末次随访：65.5°±22.8°至 112.0°±50.9°，P<.01）、MEPS（42.9±13.7 至 73.7±16.6，P<.01）和 VAS（6.6±1.3 至 4.0±2.3，P<.01）评分均有改善。OPEN 组术前 ROM 从 64.0°±23.3°改善至 118.0°±17.8°，ARTHRO 组从 66.5°±22.6°改善至 108.0°±24.0°。OPEN 组术前 MEPS 从 40.7±15.6 分改善至 73.6±16.7 分，ARTHRO 组从 44.3±12.2 分改善至 73.8±16.7 分。OPEN 组术前 VAS 从 6.9±1.2 分改善至 3.9±2.6 分，ARTHRO 组从 6.4±1.3 分改善至 4.1±2.0 分。两组中，最后随访时 VAS 评分和 MEPS 在 UHJ 狭窄组（UHJ<2mm，分级 2 和 3）均差于完整组（UHJ>2mm，分级 1）（P<.01）。
关节镜下骨囊成形术与 OPEN 手术治疗原发性肘关节炎的效果相当；然而，OPEN 手术在改善屈曲受限方面的效果更好。这两种方法都不能保证严重 UHJ 狭窄患者的良好效果。
III 级，回顾性比较试验。
