Farr Sebastian, Abualruz Mohammad M, Girsch Werner
Orthopedic Hospital Speising.
Department of Plastic Surgery, Medical University Graz, Vienna, Austria.
Tech Hand Up Extrem Surg. 2020 Mar;24(1):37-42. doi: 10.1097/BTH.0000000000000259.
Radiocapitellar arthrosis represents a serious sequela of pediatric elbow injuries. Although persistent pain and disability are not uncommon in such cases, treatment remains controversial. The present study aimed to review the clinical outcomes after a new surgical treatment with partial radial head resection and corium interposition arthroplasty. To date, 3 adolescent cases underwent the surgical procedure and postoperative care. Thorough clinical and radiographic follow-up was performed. The mean age at the time of surgery was 14.4 years (range, 13 to 16 y) and mean duration of follow-up was 19 months (range, 12 to 29 mo). The postoperative range of motion was maintained in all cases. The outcome was rated as excellent in all 3 patients for the Disabilities of the Arm, Shoulder and Hand score (mean, 3; range, 0 to 6.7) and Mayo Elbow Performance Score (mean, 92; range, 80 to 100). The mean Timmermann score; however, was still rated as fair despite marked improvements (mean, 153; range, 145 to 165). No complications such as elbow stiffness, osteophytes formation, radial head overgrowth, or proximal radius migration occurred. In pediatric isolated posttraumatic radiocapitellar arthrosis, we believe that radial head resection and corium interposition arthroplasty is an effective salvage procedure to alleviate symptoms and maintain elbow function with good to excellent clinical outcomes and no proximal migration of the radius.
桡骨头关节病是小儿肘部损伤的严重后遗症。尽管在这类病例中持续疼痛和功能障碍并不少见,但治疗方法仍存在争议。本研究旨在回顾一种新的手术治疗方法——部分桡骨头切除术和真皮植入关节成形术后的临床结果。迄今为止,3例青少年患者接受了该手术及术后护理。进行了全面的临床和影像学随访。手术时的平均年龄为14.4岁(范围13至16岁),平均随访时间为19个月(范围12至29个月)。所有病例术后活动范围均得以维持。所有3例患者的上肢、肩部和手部功能障碍评分(平均3分;范围0至6.7分)和梅奥肘关节功能评分(平均92分;范围80至100分)结果均为优秀。然而,尽管有显著改善,平均蒂姆曼评分仍被评为一般(平均153分;范围145至165分)。未发生诸如肘关节僵硬、骨赘形成、桡骨头过度生长或桡骨近端移位等并发症。对于小儿孤立性创伤后桡骨头关节病,我们认为桡骨头切除术和真皮植入关节成形术是一种有效的挽救性手术,可缓解症状并维持肘关节功能,临床结果良好至优秀,且桡骨无近端移位。