Clinic for Trauma and Orthopaedic Surgery, BG Trauma Center Ludwigshafen, University of Heidelberg, Ludwigshafen on the Rhine, Germany; German Joint Centre, ATOS Clinic Heidelberg, Heidelberg, Germany.
Clinic for Trauma and Orthopaedic Surgery, BG Trauma Center Ludwigshafen, University of Heidelberg, Ludwigshafen on the Rhine, Germany.
J Shoulder Elbow Surg. 2021 Jul;30(7):e361-e369. doi: 10.1016/j.jse.2020.11.031. Epub 2021 Jan 20.
The purposes of this study were (1) to report functional outcomes; (2) to assess complications, revisions, and survival rate; and (3) to assess differences in functional outcomes between removed and retained radial head arthroplasties (RHAs), early and delayed treatment, and type of RHA used at long-term follow-up after monopolar RHA for unreconstructible radial head fractures or their sequelae.
Seventy-eight patients (mean age, 59.2 years) who were at least 6 years postoperatively after monopolar RHA for unreconstructible RHFs or their sequelae were included. The Mayo Elbow Performance Score (MEPS); Quick Disability of the Arm, Shoulder, and Hand (QuickDASH) score; visual analog scale; postoperative satisfaction (1-6, 6 = highly unsatisfied); range of motion; complications; and revisions were assessed. Radiographic findings were reported. Kaplan-Meier survival analysis was performed. Subgroups (RHA type, early vs. delayed surgery, RHA removed vs. retained) were compared.
At a median clinical follow-up of 9.5 years (range: 6.0-28.4 years), median MEPS was 80.0 (interquartile range [IQR]: 60.0-97.5), median QuickDASH was 22.0 (IQR: 4.6-42.6), median visual analog scale was 1 (IQR: 0-4), median postoperative satisfaction was 2 (IQR: 1-3), and median arc of extension/flexion was 110° (IQR: 80°-130°). Radiographic follow-up was available for 48 patients at a median of 7.0 years (range: 2.0-15.0 years). Heterotopic ossifications were seen in 14 (29.2%), moderate-to-severe capitellar osteopenia/abrasion in 3 (6.1%), moderate-to-severe ulnohumeral degeneration in 3 (6.1%), and periprosthetic radiolucencies in 17 (35.4%) patients. Twenty-nine patients (37.2%) had complications and 20 patients (25.6%) underwent RHA exchange or removal. Kaplan-Meier analysis with failure defined as RHA exchange or removal demonstrated survival of 75.1% (95% confidence interval: 63.7-83.3) at 18 years. The highest annual failure rate was observed in the first year in which the RHAs of 7 patients (9%) were exchanged or removed. No significant differences were detected between type of RHA in MEPS (Mathys: 82.5 [75.0-100] vs. Evolve: 80.0 [60.0-95.0]; P = .341) and QuickDASH (Mathys: 12.5 [0-34.4] vs. Evolve: 26.7 [6.9-46.2]; P = .112). Early surgery (≤3 weeks) yielded significantly superior MEPS (80.0 [70.0-100.0] vs. 52.5 [30.0-83.8]; P = .014) and QuickDASH (18.6 [1.5-32.6] vs. 46.2 [31.5-75.6]; P = .002) compared with delayed surgery (>3 weeks). Patients with retained RHAs had significantly better MEPS (80.0 [67.5-100] vs. 70.0 [32.5-82.5]; P = .016) and QuickDASH (18.1 [1.7-31.9] vs. 49.1 [22.1-73.8]; P = .007) compared with patients with removed RHAs.
Long-term outcomes for RHA are satisfactory; however, there is a high complication and revision rate, resulting in implant survival of 75.1% at 18 years with the highest annual failure rate observed in the first postoperative year.
本研究的目的是：（1）报告功能结果；（2）评估并发症、翻修和生存率；（3）在单极桡骨头置换（RHA）后至少 6 年的长期随访中，评估保留和去除桡骨头假体、早期和延迟手术以及使用的 RHA 类型之间的功能结果差异。
78 例（平均年龄 59.2 岁）患者至少在单极 RHA 治疗不可重建的桡骨头骨折或其后遗症后 6 年以上进行了手术。采用 Mayo 肘功能评分（MEPS）、快速残疾的胳膊、肩膀和手（QuickDASH）评分、视觉模拟评分（VAS）、术后满意度（1-6，6 表示非常不满意）、活动范围、并发症和翻修来评估。报告影像学结果。进行 Kaplan-Meier 生存分析。比较了 RHA 类型、早期与延迟手术、保留与去除 RHA 等亚组。
在中位数为 9.5 年（范围：6.0-28.4 年）的临床随访中，中位数 MEPS 为 80.0（四分位距[IQR]：60.0-97.5），中位数 QuickDASH 为 22.0（IQR：4.6-42.6），中位数 VAS 为 1（IQR：0-4），中位数术后满意度为 2（IQR：1-3），中位数的屈伸弧为 110°（IQR：80°-130°）。48 例患者在中位数为 7.0 年（范围：2.0-15.0 年）时进行了影像学随访。14 例（29.2%）有异位骨化，3 例（6.1%）有中度至重度尺骨滑车骨骨质疏松/磨损，3 例（6.1%）有中度至重度肱尺关节退变，17 例（35.4%）有假体周围透亮区。29 例（37.2%）有并发症，20 例（25.6%）进行了 RHA 置换或去除。以 RHA 置换或去除为失败定义的 Kaplan-Meier 分析显示，18 年后 RHA 的生存率为 75.1%（95%置信区间：63.7%-83.3%）。在第一年，7 例患者（9%）的 RHA 被更换或去除，其年失败率最高。在 MEPS（Mathys：82.5[75.0-100] vs. Evolve：80.0[60.0-95.0]；P=.341）和 QuickDASH（Mathys：12.5[0-34.4] vs. Evolve：26.7[6.9-46.2]；P=.112）方面，两种 RHA 类型之间没有显著差异。早期手术（≤3 周）的 MEPS（80.0[70.0-100.0] vs. 52.5[30.0-83.8]；P=.014）和 QuickDASH（18.6[1.5-32.6] vs. 46.2[31.5-75.6]；P=.002）显著优于延迟手术（>3 周）。保留 RHA 的患者的 MEPS（80.0[67.5-100] vs. 70.0[32.5-82.5]；P=.016）和 QuickDASH（18.1[1.7-31.9] vs. 49.1[22.1-73.8]；P=.007）显著优于去除 RHA 的患者。
RHA 的长期结果令人满意，但并发症和翻修率较高，导致 18 年时的植入物生存率为 75.1%，第一年的年失败率最高。
