Department of Anatomical, Histological, Forensic Medicine and Orthopedics Sciences, "Sapienza" University of Rome-Policlinico Umberto I, Rome, Italy.
Department of Orthopedics and Traumatology, Azienda Ospedaliera San Camillo-Forlanini, Rome, Italy.
J Shoulder Elbow Surg. 2020 Apr;29(4):e103-e117. doi: 10.1016/j.jse.2019.11.021.
Chronic complex persistent elbow instability (CCPEI) is a condition that even expert elbow surgeons find challenging to treat. The results of the few studies that have dealt with the treatment of this condition are conflicting. We describe the surgical results of a consecutive prospective series of patients with CCPEI and provide a review of the recent literature.
We assessed 21 patients with previous failed surgical or conservative treatment, with a terrible-triad injury in 13, Monteggia-like lesion in 6, humeral shear fracture-dislocation in 1, and radial head fracture-dislocation in 1. Overall, 21 open débridement procedures, 15 ulnar nerve transpositions, 6 ulnar in situ neurolysis procedures, 7 total elbow arthroplasties, 8 radial head arthroplasties, 1 radial head resection with humeroradial anconeus interpositional arthroplasty, 4 coronoid graft reconstructions, 14 ligament retensioning procedures, 3 ulnar nonunion treatments, and 2 ulnar osteotomies were performed. Two dynamic external fixators were applied. The Mayo Elbow Performance Score, quick Disabilities of the Arm, Shoulder and Hand score, and modified American Shoulder and Elbow Surgeons score were used preoperatively and postoperatively.
The mean follow-up period was 29.4 months. A significant improvement was found between preoperative and postoperative clinical scores and range-of-motion values. The reintervention and major complication rates were 19% and 23%, respectively. Arthritic evolution was observed in 71% of the cases.
CCPEI is a challenging condition with an uncertain prognosis. The variability in patients' pathoanatomic conditions requires customized surgical treatment aimed at elbow stabilizer reconstruction when the ulnohumeral joint is preserved or aimed at joint replacement in case of severe articular degeneration. The time interval between the initial trauma and index surgical procedure significantly affects the feasibility of reconstructive procedures.
慢性复杂持续性肘部不稳定（CCPEI）是一种即使是经验丰富的肘部外科医生也觉得难以治疗的疾病。少数涉及这种疾病治疗的研究结果相互矛盾。我们描述了一组连续的 CCPEI 患者的手术结果，并对近期文献进行了回顾。
我们评估了 21 例既往手术或保守治疗失败的患者，其中 13 例为三联征损伤，6 例为类似孟氏骨折脱位，1 例为肱骨剪切骨折脱位，1 例为桡骨头骨折脱位。总的来说，进行了 21 例开放性清创术、15 例尺神经转位术、6 例尺神经原位松解术、7 例全肘人工关节置换术、8 例桡骨头人工关节置换术、1 例桡骨头切除肱桡肌腱间人工关节置换术、4 例喙突移植重建术、14 例韧带再紧张术、3 例尺骨不愈合治疗和 2 例尺骨截骨术。应用了 2 个动态外固定器。使用 Mayo 肘部功能评分、快速残疾的手臂、肩和手评分和改良美国肩肘外科医生评分进行术前和术后评估。
平均随访时间为 29.4 个月。术前和术后临床评分和活动范围均有显著改善。再干预和主要并发症的发生率分别为 19%和 23%。71%的病例出现关节炎进展。
CCPEI 是一种具有不确定预后的挑战性疾病。患者的病理解剖条件存在差异，需要根据情况制定个性化的手术治疗方案，当尺肱关节得以保留时，需要重建稳定结构；当关节严重退化时，则需要进行关节置换。初次创伤和初次手术之间的时间间隔显著影响重建手术的可行性。
