Morrey B F, Bryan R S
Clin Orthop Relat Res. 1982 Oct(170):204-12.
The need for revision surgery for loosening exceeds 25% with tightly constrained prostheses but is much less with the semiconstrained designs. Resurfacing prostheses may be unstable if not adequately balanced by static and dynamic soft-tissue constraints. Infection is excessive (4%-9%), but resection arthroplasty is a reasonably good salvage procedure. Implant failure is rare. The ulnar nerve is subject to transient (10%) or, occasionally, partial dysfunction. Routine anterior translocation has been beneficial, but there is considerable variation in technique in this regard. Triceps insufficiency can be virtually eliminated with the Kocher lateral-to-medial or the Bryan lateral-to-medial triceps-sparing approach. Fractures of the ulna usually can be treated by cast application, but humeral fractures may require revision surgery because of component loosening. Some complications are decreasing in frequency, whereas others are becoming more widely appreciated. The procedure remains a challenging one, and is one that should be performed by those who are experienced in elbow surgery and who have a detailed knowledge of the numerous potential pitfalls.
对于受限程度较高的假体，因松动而需要翻修手术的比例超过25%，但半受限设计的假体这一比例要低得多。如果没有通过静态和动态软组织限制实现充分平衡，表面置换假体可能会不稳定。感染发生率过高（4%-9%），但切除关节成形术是一种相当不错的挽救手术。植入物失败很少见。尺神经会出现短暂性（10%）或偶尔的部分功能障碍。常规的前路移位术是有益的，但在这方面技术存在很大差异。采用科赫尔（Kocher）外侧至内侧或布莱恩（Bryan）外侧至内侧保留肱三头肌入路，肱三头肌功能不全几乎可以消除。尺骨骨折通常可以通过石膏固定治疗，但肱骨骨折可能因假体松动而需要翻修手术。一些并发症的发生率在下降，而另一些则越来越受到广泛关注。该手术仍然具有挑战性，应由那些有肘部手术经验且对众多潜在陷阱有详细了解的人来进行。
