Department of Orthopaedics, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, Xinjiang, China.
Department of Spine, General Hospital of Xinjiang Military Region of the Chinese People's Liberation Army, Urumqi, Xinjiang, China.
J Shoulder Elbow Surg. 2023 Jul;32(7):1505-1513. doi: 10.1016/j.jse.2023.02.128. Epub 2023 Mar 21.
This study aims to investigate the clinical efficacy of the olecranon osteotomy approach and the Bryan-Morrey approach in total elbow arthroplasty (TEA).
In this retrospective study, 49 patients with elbow disease were treated with TEA. A total of 22 patients with TEA by olecranon osteotomy approach were designated as group A, and 27 patients with TEA by Bryan-Morrey approach were designated as group B. There were 22 males and 27 females, aged 32-82 years with a mean age of 62 years. There were 44 cases of unilateral elbow joint, including 27 cases on the left elbow and 17 cases on the right elbow, and 5 cases of the bilateral elbow joint. There were 6 cases of osteoarthritis (7 elbows), 18 cases of rheumatoid arthritis (22 elbows), 14 cases of traumatic arthritis (14 elbows), 7 cases of distal humeral fractures (7 elbows), and 4 cases of elbow tuberculosis (4 elbows). For each group, we recorded the operative time, intraoperative bleeding, elbow flexion, extension, pronation, supination, postoperative complication rates, and Mayo Elbow Performance Score after surgery.
Operative time and intraoperative bleeding were less in group A than in group B (53-120 min [70 (62.5, 78) min] vs. 64-105 min [77 (73, 87) min], and 10-200 ml [50 (20, 90) ml] vs. 5-250 ml [100 (50, 150) ml], P < .028). The elbow flexion, pronation activity, and Mayo Elbow Performance Score were higher in group A than in group B, [(121 ± 12)° vs. (112 ± 10)°, 85 (85,85)° vs. 80 (77,85)°, and (94 ± 3) points vs. (91 ± 4) points, P < .036], while elbow extension and supination activity and complication rates were not statistically significant in either group.
Compared to Bryan-Morrey approach, the olecranon osteotomy approach to TEA provides adequate visualization, saves operative time and reduces bleeding, provides better flexion activity, effectively improves elbow function, and achieves satisfactory clinical outcomes.
本研究旨在探讨尺骨鹰嘴截骨入路与 Bryan-Morrey 入路在全肘关节置换术（TEA）中的临床疗效。
本回顾性研究纳入了 49 例肘部疾病患者，均接受了 TEA 治疗。22 例采用尺骨鹰嘴截骨入路的患者设为 A 组，27 例采用 Bryan-Morrey 入路的患者设为 B 组。其中男 22 例，女 27 例；年龄 32~82 岁，平均 62 岁。单肘 44 例，左侧 27 例，右侧 17 例；双肘 5 例。骨关节炎 6 例（7 肘），类风湿关节炎 18 例（22 肘），创伤性关节炎 14 例（14 肘），肱骨远端骨折 7 例（7 肘），肘关节结核 4 例（4 肘）。记录每组患者的手术时间、术中出血量、肘屈伸活动度、前臂旋前旋后活动度、术后并发症发生率及术后 Mayo 肘关节功能评分。
A 组手术时间及术中出血量均少于 B 组[53120 min（70（62.5，78）min] vs. 64105 min（77（73，87）min]，5200 ml（50（20，90）ml] vs. 5250 ml（100（50，150）ml]，P 值均<.028）。A 组患者的肘屈曲活动度、前臂旋前活动度及 Mayo 肘关节功能评分均高于 B 组，[（121±12）° vs. （112±10）°，85（85，85）° vs. 80（77，85）°，（94±3）分 vs. （91±4）分]，而两组患者的肘伸屈活动度及前臂旋后活动度和并发症发生率差异均无统计学意义。
与 Bryan-Morrey 入路相比，TEA 采用尺骨鹰嘴截骨入路可提供充分的显露，节约手术时间、减少出血，提供更好的屈曲活动度，有效改善肘关节功能，获得满意的临床效果。
