Galavotti C, Padovani S, Nosenzo A, Menozzi M, Maniscalco P, Concari G, Villani C, Sabetta E, Belluati A, Monesi M, Massari L, Pari C, Cavaciocchi M, Calderazzi F, Colozza A
Ortopedia e Traumatologia POC, ASST Cremona, Viale Concordia 1, 26100, Cremona, Cremona, Italy.
Ortopedia e Traumatologia Ospedale Degli Infermi Faenza, Viale Stradone, 9, 48018, Faenza, Ravenna, Italy.
Eur J Orthop Surg Traumatol. 2022 Apr;32(3):405-411. doi: 10.1007/s00590-021-02979-1. Epub 2021 Apr 24.
The current indication for comminuted radial head fractures is radial head arthroplasty (RHA). The main purpose of this study was to investigate any statistical differences in terms of prosthesis revision or removal and radiographic degenerative changes by comparing patients who underwent RHA and ligaments repair to those who underwent only RHA implant at minimum two years follow-up. The secondary aim was to delineate a trend profile of RHA implants.
All patients who underwent RHA surgery for traumatic pathology between January 2012 and December 2017 were eligible. Two researchers independently and retrospectively reviewed the patients' charts and collected the following data: type of prosthesis, associated surgical procedures and revision surgery. They also looked for any radiographic sign of prosthesis loosening, overstuffing, capitellar osteopenia, heterotopic ossification and degenerative changes. No clinical evaluation was performed.
In 6 years, 124 RHA were implanted (74 female, 50 male, mean age 56). The main diagnoses were: terrible triad, trans-olecranon fracture and isolated radial head fracture. It was found no significant statistical difference between the 2 groups; nevertheless, the cohort of patients that underwent ligaments repair had a lower revision rate in comparison with the other. Suture of the annular ligament seems to be critical. The overall revision rate was 10.5%.
This multi-center study found no evidence that ligaments repair, as an associated surgical procedure, improves RHA longevity, except for annular ligament. Nevertheless, it seems to prevent degenerative changes at midterm follow-up.
目前对于粉碎性桡骨头骨折的治疗方法是桡骨头置换术（RHA）。本研究的主要目的是通过比较接受RHA联合韧带修复的患者与仅接受RHA植入的患者，在至少两年的随访期内，研究假体翻修或取出以及影像学退变改变方面的统计学差异。次要目的是描绘RHA植入物的趋势概况。
所有在2012年1月至2017年12月期间因创伤性病变接受RHA手术的患者均符合条件。两名研究人员独立且回顾性地查阅患者病历并收集以下数据：假体类型、相关手术操作和翻修手术。他们还查找假体松动、填充过度、肱骨小头骨质减少、异位骨化和退变改变的任何影像学征象。未进行临床评估。
6年间，共植入124例RHA（女性74例，男性50例，平均年龄56岁）。主要诊断为：可怕三联征、经鹰嘴骨折和单纯桡骨头骨折。发现两组之间无显著统计学差异；然而，接受韧带修复的患者队列与另一组相比翻修率较低。环状韧带缝合似乎至关重要。总体翻修率为10.5%。
这项多中心研究没有发现证据表明作为相关手术操作的韧带修复能提高RHA的使用寿命，但环状韧带除外。不过，在中期随访中它似乎能预防退变改变。
