Ljung P, Jonsson K, Larsson K, Rydholm U
Department of Orthopedics, University Hospital, Lund, Sweden.
J Shoulder Elbow Surg. 1996 Mar-Apr;5(2 Pt 1):81-5. doi: 10.1016/s1058-2746(96)80001-2.
Radiographic bone loss and clinical outcome were evaluated at a median of 6 years after interposition arthroplasty was performed in 35 elbows with rheumatoid arthritis. Seven early postoperative complications, two major and five minor, occurred. Three elbows subsequently required total elbow replacement. Clinical results were good in terms of pain relief but only fair in terms of joint mobility and stability. Radiographic elbow destruction progressed to a higher Larsen stage in half of the elbows. Measurements revealed humeral bone loss in two thirds of the elbows and ulnar bone loss in one third. In comparison with total elbow replacement, the long-term results of interposition arthroplasty were found to be inferior, with a total elbow replacement being required in one tenth of the elbows in the long term. In addition, bone loss often became extensive, making reoperation difficult or impossible. The authors recommend total elbow replacement as the first choice in the surgical treatment of the painful elbow with rheumatoid arthritis and cartilage destruction.
对35例类风湿性关节炎患者的肘关节进行间置关节成形术后，在中位时间6年时评估影像学骨丢失情况和临床结局。术后早期出现了7例并发症，其中2例严重，5例轻微。随后有3例肘关节需要进行全肘关节置换。临床结果在疼痛缓解方面良好，但在关节活动度和稳定性方面仅为一般。影像学显示，半数肘关节的肘关节破坏进展到更高的 Larsen 分期。测量结果显示，三分之二的肘关节有肱骨骨丢失，三分之一有尺骨骨丢失。与全肘关节置换相比，发现间置关节成形术的长期结果较差，长期来看十分之一的肘关节需要进行全肘关节置换。此外，骨丢失常常变得广泛，导致再次手术困难或无法进行。作者推荐全肘关节置换作为类风湿性关节炎伴软骨破坏的疼痛性肘关节外科治疗的首选方法。
