Pucher Christoph-Johannes, Leschinger Tim, Ott Nadine, Müller Lars Peter, Hackl Michael
Schwerpunkt für Unfall‑, Hand- und Ellenbogenchirurgie, Universitätsklinikum Köln (AöR), Kerpener Str. 62, 50937, Köln, Deutschland.
Oper Orthop Traumatol. 2024 Aug;36(3-4):167-179. doi: 10.1007/s00064-024-00847-9. Epub 2024 Jul 31.
Interposition arthroplasty of the elbow involves the interposition of a fascia lata or dermis autograft or allograft between the distal humerus and the ulna or radius, while preserving the original form of articulation.
Interposition arthroplasty is indicated for young patients with high functional demands who suffer from end-stage elbow arthritis and associated pain or joint stiffness.
Contraindications include acute or subacute infection, skeletal immaturity, bone loss, deformity, or gross instability.
Once the ulnar nerve has been secured, joint access is established via a posterior approach. The radial collateral ligament (RCL) and the common extensor tendon origin (CEO) are detached, while preserving the anconeus muscle and the lateral ulnar collateral ligament (LUCL). Subsequently, a capsular release is required to maintain adequate joint exposure and address the accompanying stiffness. Three to four transosseous drill holes are placed at the level of the distal humerus to secure the graft. After the graft has been positioned successfully within the joint space using two guide sutures, it can be secured to the distal humerus using a horizontal mattress stitch. Finally, the detached tendon and ligament structures are reconstructed.
After initial immobilization, early functional exercise of the elbow is performed in the motion orthosis, avoiding valgus or varus stress.
The efficacy of elbow interposition arthroplasty has been demonstrated, particularly for young and active patients with severe inflammatory or post-traumatic osteoarthritis. Despite the results in terms of postoperative function and pain reduction are satisfactory, the current literature reports high complication, subsequent treatment, and revision rates. In the event of interposition arthroplasty failure, revision with another interposition procedure or conversion to endoprosthesis may be considered.
肘关节间置关节成形术是在肱骨远端与尺骨或桡骨之间置入阔筋膜张肌或真皮自体移植片或同种异体移植片，同时保留原始关节形态。
间置关节成形术适用于对功能要求较高、患有终末期肘关节关节炎及相关疼痛或关节僵硬的年轻患者。
禁忌证包括急性或亚急性感染、骨骼未成熟、骨质流失、畸形或严重不稳定。
在保护尺神经后，经后路进入关节。在保留肘肌和尺侧副韧带（LUCL）的同时，切断桡侧副韧带（RCL）和伸肌总腱起点（CEO）。随后，需要进行关节囊松解以保持充分的关节暴露并解决伴随的僵硬问题。在肱骨远端水平钻3至4个穿骨孔以固定移植片。使用两根引导缝线将移植片成功置于关节间隙后，可用水平褥式缝合法将其固定于肱骨远端。最后，重建切断的肌腱和韧带结构。
初始固定后，在运动矫形器中对肘关节进行早期功能锻炼，避免外翻或内翻应力。
肘关节间置关节成形术的疗效已得到证实，尤其是对于患有严重炎症性或创伤后骨关节炎的年轻活跃患者。尽管术后功能和疼痛减轻方面的结果令人满意，但目前的文献报道并发症、后续治疗和翻修率较高。如果间置关节成形术失败，可考虑采用另一种间置手术进行翻修或转换为假体植入。
