Department of Orthopaedic Surgery, iULS, University of Nice Sophia-Antipolis, Nice, France.
Trousseau University Hospital, Tours, France.
Int Orthop. 2021 Jun;45(6):1549-1557. doi: 10.1007/s00264-021-04987-6. Epub 2021 Mar 8.
The aim was to evaluate the results of radial head prostheses (RHP) in Essex-Lopresti injury (ELI) and to compare results after RHP between acute and chronic ELI.
Thirty-one patients treated with RHP for ELI were selected from a multicenter retrospective series of 310 RHP, with follow-up greater than two years. Two groups were acute ELI group (n=19, average diagnosis = 5+/-9 days) and chronic ELI group (n=12, average diagnosis 8.4+/-7.1 months). RHP was associated in some cases with K-wires: during acute ELI to stabilize the distal radio-ulnar joint (n=4) or during chronic ELI with ulnar osteotomy or palliative surgery (n=4). Clinical and radiologic evaluation was performed including analysis of the complications and revisions rates, pain level, range of motion, and MEPS (Mayo Elbow Performance Score) and DASH score (Disabilities of the Arm, Shoulder and Hand).
At last follow-up (71+/-38 months), survival of RHP in the acute ELI group was 84% (16/19) and 92% (11/12) in the chronic ELI group without statistically significant difference. Flexion (acute=131degrees+/-13.4 vs chronic=22+/-12.8, p=0.041) and supination (ELI=71+/-16.8 vs chronic=58+/-17.4; p=0.045) were better in acute ELI group. The DASH score was also better in the acute group (15+/-9.1 versus 24+/-15.2, p=0.048). There was more advanced stage of humero-radial osteoarthritis in the chronic ELI group (0.7+/-0.5 versus 1.4+/-0.6, p=0.041).
RHP in acute ELIs provide better clinical results, although RHPs are part of the therapeutic arsenal to treat chronic ELI.
评估桡骨头假体（RHP）在 Essex-Lopresti 损伤（ELI）中的治疗效果，并比较急性和慢性 ELI 患者接受 RHP 治疗后的结果。
从 310 例接受 RHP 治疗的桡骨头假体患者中选择了 31 例接受 RHP 治疗的 Essex-Lopresti 损伤患者，这些患者的随访时间均超过 2 年。将这些患者分为急性 ELI 组（n=19，平均发病时间为 5+/-9 天）和慢性 ELI 组（n=12，平均发病时间为 8.4+/-7.1 个月）。在某些情况下，RHP 与 K 线结合使用：在急性 ELI 中，将 K 线用于稳定桡尺远侧关节（n=4），或在慢性 ELI 中，将 K 线用于尺骨截骨术或姑息性手术（n=4）。对这些患者进行了临床和影像学评估，包括并发症和翻修率、疼痛程度、活动范围以及 Mayo 肘功能评分（MEPS）和残疾程度（手臂、肩部和手）评分（DASH）的分析。
末次随访（71+/-38 个月）时，急性 ELI 组的 RHP 生存率为 84%（16/19），慢性 ELI 组为 92%（11/12），两组间无统计学差异。急性 ELI 组的屈曲度（131 度+/-13.4 度 vs 慢性 ELI 组的 22 度+/-12.8 度，p=0.041）和旋前度（ELI=71+/-16.8 度 vs 慢性 ELI 组的 58+/-17.4 度；p=0.045）均优于慢性 ELI 组。急性 ELI 组的 DASH 评分也更好（15+/-9.1 分 vs 24+/-15.2 分，p=0.048）。慢性 ELI 组的桡肱关节炎更严重（0.7+/-0.5 级 vs 1.4+/-0.6 级，p=0.041）。
急性 Essex-Lopresti 损伤患者接受 RHP 治疗的临床效果更好，尽管 RHP 是治疗慢性 ELI 的治疗方案之一。
