Morrey M, Dutta A, Whitney I, Morrey B
Department of Orthopaedic Surgery, Mayo Clinic, Rochester, MN, 55905, USA.
Department of Orthopaedic Surgery, University of Texas Health Center, San Antonio, TX, 78229, USA.
J Clin Orthop Trauma. 2021 May 19;19:175-182. doi: 10.1016/j.jcot.2021.05.023. eCollection 2021 Aug.
The ultimate means of functional restoration of joints with end stage arthritis is prosthetic replacement. Even though there is reluctance to replace the joint of a younger individual, the mean age of joint replacement continues to decrease. This is due to three factors: 1) social expectations, 2) uncertainty with many joint preservation procedures and 3) the ever-increasing reliability and longevity of prosthetic replacement. Unfortunately, the elbow does not share in these advantageous trends to the extent as is the case for the hip, knee and shoulder. Social pressure for restoration of normal or near normal function is certainly present, but the desired improvement of longevity and fewer restrictions of activity have not been documented. Hence, possibly somewhat disproportionately to other joints, there is great need for a reliable and functional non replacement joint reconstruction option. For most other joints, fusion is the ultimate non replacement option. Further, for most joints an optimum position has been defined to allow the greatest chance of normal function of the individual. Unfortunately, there is no truly 'optimum' functional position of elbow fusion, and the recommended 90° of flexion is considered the 'least worse' position. Further, unfortunately, elbow fusion dysfunction cannot be mitigated by compensated shoulder motion. Hence, while there is little experience in general with interposition arthroplasty of the elbow, in the authors' opinion it remains the treatment of choice in some individuals and in certain circumstances for the reasons explained above. In our judgment, the reason for avoiding this procedure is that it is technically difficult, the absolute frequency of need is not great, and outcomes do appear to be a function of experience and technique. Based on these considerations, in this chapter we review the current indications and assessment and selection considerations. Emphasis is placed on our current technique with technical tips to enhance the likelihood of success and longevity. We conclude with a review of expectations based on current literature.
终末期关节炎关节功能恢复的最终手段是假体置换。尽管人们不太愿意为较年轻的个体置换关节，但关节置换的平均年龄仍在持续下降。这归因于三个因素：1）社会期望；2）许多关节保留手术存在不确定性；3）假体置换的可靠性和使用寿命不断提高。不幸的是，与髋、膝和肩关节相比，肘关节并未充分受益于这些有利趋势。恢复正常或接近正常功能的社会压力固然存在，但假体置换在延长使用寿命以及减少活动限制方面所期望达到的改善效果尚无文献记载。因此，与其他关节相比，肘关节可能有些不成比例地迫切需要一种可靠且具有功能的非置换性关节重建方案。对于大多数其他关节而言，融合是最终的非置换选择。此外，对于大多数关节，已确定了最佳位置，以使个体获得正常功能的最大机会。不幸的是，肘关节融合没有真正的“最佳”功能位置，推荐的90°屈曲被认为是“最不差”的位置。而且，不幸的是，肘关节融合功能障碍无法通过代偿性的肩部活动得到缓解。因此，尽管肘关节间置关节成形术总体经验较少，但在作者看来，基于上述原因，在某些个体和特定情况下，它仍是首选治疗方法。我们认为，避免采用这种手术的原因在于其技术难度大，绝对需求频率不高，而且手术效果似乎确实取决于经验和技术。基于这些考虑，在本章中我们将回顾当前的适应症、评估及选择考量因素。重点是我们目前的技术以及有助于提高成功率和使用寿命的技术要点。我们将基于当前文献对预期结果进行综述作为结尾。
