Schemitsch E H, Ewald F C, Thornhill T S
Department of Orthopaedic Surgery, Brigham and Women's Hospital, Boston, Massachusetts 02115, USA.
J Bone Joint Surg Am. 1996 Oct;78(10):1541-7. doi: 10.2106/00004623-199610000-00012.
We compared the results of twenty-three consecutive capitellocondylar total elbow arthroplasties in twenty-three patients in whom an excision of the radial head and synovectomy for rheumatoid arthritis had failed with those of twenty-three non-consecutive primary capitellocondylar total elbow arthroplasties in twenty-three patients who had rheumatoid arthritis. The two groups were matched for age, gender, duration of follow-up, side of the operation, type of prosthesis, and operative approach. The average duration of follow-up was four years (range, two to fourteen years). At the most recent follow-up examination, use of a 100-point rating system demonstrated an improvement from an average preoperative score of 21 points (range, 12 to 42 points) to an average postoperative score of 87 points (range, 17 to 97 points) for the group in whom an excision of the radial head and synovectomy had failed. The group that had primary arthroplasty demonstrated an improvement from an average preoperative score of 22 points (range, 7 to 42 points) to an average postoperative score of 94 points (range, 85 to 100 points). The group that had primary arthroplasty had a significantly greater improvement in terms of relief of pain (p < 0.05), functional status (p < 0.01), and the elbow-rating score (p < 0.03) than the other group. Four patients who had had failure of an excision of the radial head and synovectomy and none of those who had primary arthroplasty needed an additional operative procedure. Six of the patients who had had a failed excision and synovectomy and none of the patients who had primary arthroplasty had instability of the elbow components. We concluded that, although excision of the radial head and synovectomy is a conservative and effective method of treating a painful rheumatoid elbow, conversion to a capitellocondylar total elbow arthroplasty is more difficult after such an operation and the results at a minimum of two years are inferior to those for primary capitellocondylar total elbow arthroplasty.
我们将23例因类风湿关节炎行桡骨头切除及滑膜切除术失败的患者接受的连续23例髁间全肘关节置换术的结果，与23例患有类风湿关节炎的患者接受的23例非连续初次髁间全肘关节置换术的结果进行了比较。两组在年龄、性别、随访时间、手术侧别、假体类型和手术入路方面进行了匹配。平均随访时间为4年（范围为2至14年）。在最近的随访检查中，使用100分评分系统显示，对于桡骨头切除及滑膜切除术失败的组，术前平均评分为21分（范围为12至42分），术后平均评分为87分（范围为17至97分）。接受初次置换术的组术前平均评分为22分（范围为7至42分），术后平均评分为94分（范围为85至100分）。接受初次置换术的组在疼痛缓解（p < 0.05）、功能状态（p < 0.01）和肘关节评分（p < 0.03）方面的改善明显大于另一组。4例桡骨头切除及滑膜切除术失败的患者和接受初次置换术的患者中均无一人需要再次手术。6例切除及滑膜切除术失败的患者出现肘关节部件不稳定，而接受初次置换术的患者中无一例出现这种情况。我们得出结论，虽然桡骨头切除及滑膜切除术是治疗疼痛性类风湿性肘关节的一种保守且有效的方法，但在此类手术后转换为髁间全肘关节置换术更为困难，且至少两年的结果不如初次髁间全肘关节置换术。
