Page Richard S, Paltoglou Nicholas G, Arora Varun, Eng Kevin, Gill Stephen D
Barwon Centre for Orthopaedic Research and Education (B-CORE), University Hospital Geelong, Geelong, VIC, Australia.
St. John of God Hospital Geelong, Geelong, VIC, Australia.
JSES Rev Rep Tech. 2021 Sep 3;1(4):376-380. doi: 10.1016/j.xrrt.2021.08.006. eCollection 2021 Nov.
Radial head arthroplasty is the preferred surgical management for complex, unreconstructable radial head fractures. There has been increasing use of pyrocarbon prostheses, with potential tribology and modulus advantages over metallic counterparts. This study aims to assess clinical and radiological outcomes for radial head replacement after trauma using a modular, uncemented pyrocarbon prosthesis.
Between September 2009 and March 2020, a consecutive series of 22 trauma cases were available for review. Patients underwent radial head arthroplasty using a pyrocarbon prosthesis (Ascension Modular Radial Head System, Austin, TX). Recorded outcomes included clinical assessment, radiological evaluation, and patient-reported outcome measures specific to elbow function.
Twenty-two patients (7 male, 15 female) with an average age of 51 years (range 21-64) were analyzed with a minimum 12 months of follow-up. All patients had complex radial head fractures, categorized as a Mason 3 or 4 injury. At follow-up, mean elbow range of motion included flexion 130° (range 100°-150°), extension 19° (0-50°), pronation 73° (30°-90°), and supination 70° (10°-90°). The mean Mayo Elbow Performance Index score was 83 (55-100), and Disabilities of the Arm, Shoulder and Hand score was 22 (2.5-60). Radiological evaluation showed 14 patients with asymptomatic proximal neck resorption and two patients with radiological stem loosening. In total, 3 of 22 implants were revised-2 were excised, and 1 revised to a long stem for traumatic implant fracture.
Pyrocarbon radial head arthroplasty provided reliable functional results for patients after unreconstructable radial head fracture. The unique potential for fracture of the prosthesis should be considered in long-term follow-up, with appropriate activity advice to patients.
桡骨头置换术是复杂的、无法重建的桡骨头骨折首选的手术治疗方法。热解碳假体的使用越来越多，与金属假体相比，它在摩擦学和模量方面具有潜在优势。本研究旨在评估使用模块化、非骨水泥热解碳假体进行创伤后桡骨头置换的临床和影像学结果。
在2009年9月至2020年3月期间，连续有22例创伤病例可供回顾。患者接受了使用热解碳假体（Ascension模块化桡骨头系统，得克萨斯州奥斯汀）的桡骨头置换术。记录的结果包括临床评估、影像学评估以及特定于肘部功能的患者报告结局指标。
对22例患者（7例男性，15例女性）进行了分析，平均年龄51岁（范围21 - 64岁），随访时间至少12个月。所有患者均有复杂的桡骨头骨折，分类为Mason 3或4型损伤。随访时，肘部平均活动范围包括屈曲130°（范围100° - 150°）、伸展19°（0 - 50°）、旋前73°（30° - 90°）和旋后70°（10° - 90°）。梅奥肘部功能指数平均评分为83（55 - 100），手臂、肩部和手部功能障碍评分为22（2.5 - 60）。影像学评估显示14例患者有无症状的近端颈部吸收，2例患者有影像学上的柄松动。22枚植入物中共有3枚进行了翻修——2枚被切除，1枚因创伤性植入物骨折翻修为长柄。
热解碳桡骨头置换术为无法重建的桡骨头骨折患者提供了可靠的功能结果。在长期随访中应考虑假体骨折的独特可能性，并向患者提供适当的活动建议。
