Brogren Elisabeth, Abramo Antonio, Tägil Magnus
Department of Hand Surgery, Skåne University Hospital, Malmö, Sweden.
Department of Translational Medicine, Lund University, Lund, Sweden.
J Wrist Surg. 2022 Jan 20;11(5):425-432. doi: 10.1055/s-0041-1742098. eCollection 2022 Oct.
Ulna head arthroplasty has become an eligible solution for injury or disease in the distal radioulnar joint. Bone resorption beneath the prosthetic head is often reported, but mechanism poorly understood. The aims were to evaluate bone remodeling and radiological instability in two conceptually different distal radioulnar joint arthroplasties: the total and the partial ulna head replacement. We conducted a retrospective radiographic assessment of 51 ulna head arthroplasties; 26 Herbert ulna (total ulna head replacement) and 25 First Choice (partial ulna head replacement), to analyze periprosthetic bone resorption and radiologic instability. Intraoperative/immediate postoperative and 1-year radiographs were reviewed by two independent assessors. The radiographic follow-up averaged 13 (10-17) months. The size of the stem in relation to the diameter of the ulna (filling ratio) was measured on the intraoperative/immediate postoperative radiographs. Bone resorption beneath the collar of the prothesis was measured on the 1-year radiographs and expressed as a bone resorption index (BRI) between the length of the resorption and the length of the implant stem. Radiological stability was measured on both the preoperative and the 1-year lateral radiographs. The total ulna head prothesis presented with more extensive bone resorption beneath the prosthetic head than the partial ulna head prothesis at 1-year post surgery ( <0.001). The filling ratio did not influence the 1-year bone resorption and there was no difference regarding radiological instability between the two prosthetic designs. The pattern of bone adaptions after an ulna head prothesis may differ due to design and concept of the prosthesis.
尺骨头置换术已成为桡尺远侧关节损伤或疾病的一种合适解决方案。假体头部下方的骨吸收情况常有报道，但机制尚不清楚。本研究旨在评估两种概念上不同的桡尺远侧关节置换术（全尺骨头置换和部分尺骨头置换）中的骨重塑和影像学不稳定情况。我们对51例尺骨头置换术进行了回顾性影像学评估，其中26例采用Herbert尺骨假体（全尺骨头置换），25例采用First Choice假体（部分尺骨头置换），以分析假体周围骨吸收和影像学不稳定情况。两名独立评估人员对术中/术后即刻及1年时的X线片进行了评估。影像学随访平均为13（10 - 17）个月。在术中/术后即刻X线片上测量柄部尺寸与尺骨直径的关系（填充率）。在1年时的X线片上测量假体柄部下方的骨吸收情况，并以骨吸收长度与假体柄部长度之间的骨吸收指数（BRI）表示。在术前及1年时的侧位X线片上测量影像学稳定性。术后1年时，全尺骨头假体的假体头部下方骨吸收比部分尺骨头假体更广泛（<0.001）。填充率不影响1年时的骨吸收，两种假体设计在影像学不稳定方面无差异。尺骨头假体植入后的骨适应模式可能因假体设计和理念不同而有所差异。
