Cheema Adnan N, Conyer Ryan T, Triplet Jacob J, O'Driscoll Shawn W, Morrey Mark E, Sanchez-Sotelo Joaquín
Division of Shoulder and Elbow Surgery, Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota.
JB JS Open Access. 2023 Oct 3;8(4). doi: 10.2106/JBJS.OA.22.00136. eCollection 2023 Oct-Dec.
Traditionally, the reconstruction of severe distal humeral bone loss at the time of revision total elbow arthroplasty (TEA) has used allograft-prosthetic composites (APCs) stabilized with cerclage wires or cables. We have migrated to plate fixation when revision TEA using a humeral APC is performed. This study shows the outcomes of patients treated with a humeral APC with plate fixation during revision TEA.
Between 2009 and 2019, 41 humeral APCs with plate fixation of distal humeral allograft to the native humerus were performed in the setting of revision TEA. There were 12 male patients (29%) and 29 female patients (71%), with a mean age of 63 years (range, 41 to 87 years). The mean allograft length was 12 cm. All elbows had a minimum follow-up of 2 years (mean follow-up, 3.3 years). Patients were evaluated for visual analog scale pain scores, range of motion, the ability to perform select activities of daily living, and the Mayo Elbow Performance Score (MEPS). Outcomes including reoperations, complications, and revisions were noted. The most recent radiographs were evaluated for union at the allograft-host interface, failure of the plate-and-screw construct, or component loosening.
The mean postoperative flexion was 124° (range, 60° to 150°) and the mean postoperative extension was 26° (range, 0° to 90°); the mean arc of motion was 99° (range, 30° to 150°). The mean MEPS was 58 points (range, 10 to 100 points). Two surgical procedures were complicated by neurologic deficits. The overall reoperation rate was 14 (34%) of 41. Of the 33 patients with complete radiographic follow-up, 12 (36%) had evidence of nonunion at the allograft-host interface with humeral component loosening, 1 (3%) had evidence of partial union, and 1 (3%) had ulnar stem loosening.
Revision TEA with a humeral APC using compression plating was successful in approximately two-thirds of the elbows. Further refinement of surgical techniques is needed to improve union rates in these complex cases.
Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.
传统上，在翻修全肘关节置换术（TEA）时，严重的肱骨远端骨缺损重建采用同种异体骨-假体复合物（APC）并用环扎钢丝或缆线固定。在进行使用肱骨APC的翻修TEA时，我们已改用钢板固定。本研究展示了在翻修TEA期间采用钢板固定的肱骨APC治疗患者的结果。
2009年至2019年期间，在翻修TEA的情况下，对41例采用钢板将肱骨远端同种异体骨固定于自体肱骨的肱骨APC进行了手术。有12例男性患者（29%）和29例女性患者（71%），平均年龄63岁（范围41至87岁）。同种异体骨平均长度为12厘米。所有肘关节的最短随访时间为2年（平均随访3.3年）。对患者进行视觉模拟评分法疼痛评分、活动范围、进行特定日常生活活动的能力以及梅奥肘关节功能评分（MEPS）评估。记录包括再次手术、并发症和翻修等结果。评估最新的X线片以了解同种异体骨-宿主界面的骨愈合情况、钢板-螺钉结构失败或假体松动情况。
术后平均屈曲角度为124°（范围60°至150°），术后平均伸展角度为26°（范围0°至90°）；平均活动弧度为99°（范围30°至150°）。平均MEPS为58分（范围10至100分）。有2例手术出现神经功能缺损并发症。41例患者中总的再次手术率为14例（34%）。在33例有完整影像学随访的患者中，12例（36%）在同种异体骨-宿主界面有骨不连且肱骨假体松动的证据，1例（3%）有部分骨愈合的证据，1例（3%）有尺骨柄松动。
采用加压钢板的肱骨APC进行翻修TEA在大约三分之二的肘关节手术中取得成功。在这些复杂病例中，需要进一步改进手术技术以提高骨愈合率。
治疗性四级。有关证据水平的完整描述，请参阅作者须知。
