桡骨头置换治疗急性桡骨头骨折：三种假体设计（带或不带骨水泥固定）的结果和生存率。

Radial Head Replacement for Acute Radial Head Fractures: Outcome and Survival of Three Implant Designs With and Without Cement Fixation.

机构信息

Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN.

出版信息

J Orthop Trauma. 2021 Jun 1;35(6):e202-e208. doi: 10.1097/BOT.0000000000001983.

DOI:10.1097/BOT.0000000000001983

PMID:34006797

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC8115875/

Abstract

OBJECTIVES

To determine outcomes of radial head replacement (RHR) for acute fractures using 3 different implant designs with or without cement fixation.

DESIGN

Retrospective.

SETTING

Tertiary referral hospital.

PATIENTS/PARTICIPANTS: One hundred fourteen elbows underwent RHR for an acute radial head fracture using either (1) a nonanatomic design and smooth stem (n = 60), (2) a nonanatomic design with a grit-blasted, ingrowth, curved stem (n = 21), or (3) an anatomic design with a grit-blasted ingrowth straight stem (n = 33). Cemented (25%) or uncemented (75%) fixation was used at the discretion of the treating surgeon.

INTERVENTION

RHR.

MAIN OUTCOME MEASUREMENTS

The primary outcome was implant survivorship free of revision or removal for any reason. All elbows were evaluated clinically (the Mayo Elbow Performance Score and reoperations/complications) and radiographically.

RESULTS

Fourteen implants (12%) were revised. Of elbows with a minimum 2-year clinical follow-up, the average Mayo Elbow Performance Score was 88. The rate of survivorship free from revision was 92% [95% confidence interval (CI) = 87%-98%] at 2 years, 90% (CI = 84%-96%) at 5 years and 84% (CI = 75%-94%) at 10 years. The differences in survivorship between the 3 implants did not reach statistical significance, but the nonanatomic design with a grit-blasted ingrowth curved stem had a hazard ratio of 4.6 (95% CI = 0.9%-23%) for failure. There were no differences in survivorship between cemented versus uncemented stems. For those elbows with a minimum of 2 years of radiographic follow-up, implant tilt was observed in 10 (16%) elbows and loosening in 16 (26%) elbows. Stress shielding was present in 19 (42%) of well-fixed implants.

CONCLUSIONS

RHR for acute trauma leads to survivorship greater than 80% at 10 years. Radiographic changes (loosening, stress shielding, and implant tilting) can be expected in a substantial portion of elbows at long-term follow-up.

LEVEL OF EVIDENCE

Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.

摘要

目的

使用 3 种不同的植入物设计（带或不带水泥固定），确定桡骨小头置换（RHR）治疗急性骨折的结果。

设计

回顾性研究。

地点

三级转诊医院。

患者/参与者：114 例肘部因急性桡骨小头骨折行 RHR，分别采用（1）非解剖设计和光滑柄（n=60）、（2）非解剖设计加砂喷砂、内生长、弯曲柄（n=21）或（3）解剖设计加砂喷砂内生长直柄（n=33）。根据治疗医生的判断，使用水泥固定（25%）或非水泥固定（75%）。

干预措施

RHR。

主要观察指标

主要结果是任何原因导致的无翻修或无移除的植入物存活率。所有肘部均进行临床评估（ Mayo 肘功能评分和再手术/并发症）和影像学评估。

结果

14 例植入物（12%）进行了翻修。在至少 2 年临床随访的肘部中，平均 Mayo 肘功能评分为 88 分。无翻修存活率为 2 年时 92%（95%可信区间[CI]：87%-98%），5 年时 90%（CI：84%-96%），10 年时 84%（CI：75%-94%）。3 种植入物之间的存活率差异无统计学意义，但砂喷内生长弯曲柄的非解剖设计失败的风险比为 4.6（95%CI：0.9%-23%）。水泥固定与非水泥固定的植入物之间无存活率差异。在至少有 2 年影像学随访的肘部中，10 例（16%）出现植入物倾斜，16 例（26%）出现松动。19 例（42%）固定良好的植入物出现应力遮挡。