Ahmed Parvez, Debbarma Ijack, Ameer Faisal
Department of Orthopaedics, L.L.R.M. Medical College, Meerut, India.
Central Institute of Orthopaedics, VMMC and Safdarjung Hospital, New Delhi, India.
J Clin Orthop Trauma. 2020 Jul;11(Suppl 4):S610-S620. doi: 10.1016/j.jcot.2019.08.019. Epub 2019 Sep 2.
Interposition arthroplasty (IA) is one of the oldest reconstructive options for elbow arthritis and is an alternative to total elbow arthroplasty in young active patients with moderate to severe elbow arthritis. In literature there is very little, if any, mention about relationship of post-operative functional recovery and time. In this study we assess the clinical and functional outcome of interposition arthroplasty using abdominal dermal graft.
Study was conducted retrospective and prospectively during 2014-15 on 18 elbows of 17 patients (10 females and 7 male) which were operated between 2010 and 2015 for elbow arthritis by interposition arthroplasty using abdominal dermal graft by a single surgeon. Etiologically 10 cases were post-traumatic, 4 cases inflammatory joint disease and 4 cases were post-tubercular. All patients were operated using standard kochers approach and above elbow Plaster of Paris were applied in 90° flexion and mid prone position till suture removal i.e. 2 weeks and range of motion (ROM) exercises started. Post-operatively patients were reviewed on 1, 3, 6, 9, 12 months and then yearly. Functional assessments were done using Mayo Elbow Performance Score (MEPS).
The mean age of the patients were 34.33 years (16 years-50 years) and follow-up duration of median 22 months (minimum 12 months and maximum 50 months). Pre-operative the ROM of the patients were 0°-75° with median value of 25° which were significantly improved to 55°-135° with median value of 120° which was statistically significant with p-value of less than 0.01. Preoperative MEPS were 15-70 with median value of 45 which was improved to 85 to 100 with median value of 95 with p-value less than 0.01. Post-operatively 14 elbows (77.8%) has excellent and 4 elbows (22.2%) has good result. 5 (27.7%) elbow has mild instability and in 3 patients has hypertrophic scar over donor site.
It's a very cost effective treatment as compared to total elbow arthroplasty. It provides superior functional outcome than other kind of salvageable procedure like arthrodesis and patient's satisfaction is very high after surgery as pain subsided and range of motion improved. Most of the patients returned to their previous occupation by 6 months after surgery.
间置关节成形术（IA）是治疗肘关节关节炎最古老的重建方法之一，对于患有中度至重度肘关节关节炎的年轻活跃患者而言，是全肘关节置换术的一种替代方案。在文献中，几乎没有提及术后功能恢复与时间的关系。在本研究中，我们评估了使用腹部真皮移植进行间置关节成形术的临床和功能结果。
本研究在2014年至2015年期间进行，回顾性和前瞻性地纳入了17例患者的18个肘关节（10例女性和7例男性），这些患者在2010年至2015年间由同一位外科医生使用腹部真皮移植进行间置关节成形术治疗肘关节关节炎。病因学上，10例为创伤后，4例为炎性关节疾病，4例为结核后。所有患者均采用标准的 Kocher 入路进行手术，并在肘关节屈曲90°和俯卧位中间位置应用上臂石膏，直至拆线即2周，然后开始进行关节活动度（ROM）练习。术后对患者进行1、3、6、9、12个月的复查，然后每年复查一次。使用梅奥肘关节功能评分（MEPS）进行功能评估。
患者的平均年龄为34.33岁（16岁至50岁），中位随访时间为22个月（最短12个月，最长50个月）。术前患者的ROM为0°至75°，中位值为25°，术后显著改善至55°至135°，中位值为120°，p值小于0.01，具有统计学意义。术前MEPS为15至70，中位值为45，术后改善至85至100，中位值为95，p值小于0.01。术后14个肘关节（77.8%）效果极佳，4个肘关节（22.2%）效果良好。5个（27.7%）肘关节有轻度不稳定，3例患者供区有增生性瘢痕。
与全肘关节置换术相比，这是一种非常经济有效的治疗方法。它提供了比其他可挽救的手术如关节融合术更好的功能结果，并且患者术后满意度很高，因为疼痛减轻且活动范围改善。大多数患者在术后6个月恢复到之前的工作岗位。
