Connor P M, Morrey B F
Miller Orthopaedic Clinic, Charlotte, North Carolina 28203, USA.
J Bone Joint Surg Am. 1998 May;80(5):678-88. doi: 10.2106/00004623-199805000-00008.
Patients who have juvenile rheumatoid arthritis often are seen at a very young age because of severe stiffness and pain in several joints. While total elbow replacement may be indicated in these patients, this procedure is difficult to perform because of contracture of the soft tissues and the extremely small bones and intramedullary cavities in these patients. As there is little information in the literature regarding this procedure, we attempted to learn about the long-term results by evaluating nineteen patients (twenty-four elbows) with juvenile rheumatoid arthritis who had been managed with total elbow arthroplasty. At an average of 7.4 years (range, two to fourteen years) after the operation, there was an improvement in the average Mayo elbow performance score from 31 points (range, 5 to 55 points) preoperatively to 90 points (range, 55 to 100 points). Twenty-two (96 per cent) of the twenty-three elbows available at the most recent follow-up evaluation caused little or no pain, but the improvement in the range of motion was not as reliable. The average arc of flexion improved from only 63 degrees preoperatively to 90 degrees postoperatively; the average postoperative arc of flexion began at 35 degrees, with additional flexion to 125 degrees. Examination of the four elbows that had been ankylosed before the procedure revealed an average arc of 73 degrees after the operation, and evaluation of the twenty ipsilateral wrists that were not limited by disease revealed that pronation and supination had been maintained. The average functional score improved from 9 points (range, 0 to 25 points) preoperatively to 23 points (range, 15 to 25 points) postoperatively (p < 0.001). The function of eighteen elbows (78 per cent) did not adversely affect the ability to perform activities of daily living. There were thirteen complications, including one perioperative death, that affected twelve of the twenty-four elbows. Seven of the nine early complications, including a fracture of the olecranon, subluxation of the prosthesis, stiffness of the elbow, and problems with wound-healing, led to an additional operative procedure but did not adversely affect the long-term outcome after appropriate diagnosis and treatment. Late complications (aseptic loosening, instability, and worn bushings) led to three poor results. None of the eighteen semiconstrained prostheses had radiographic evidence of loosening at the most recent follow-up evaluation. Of the twenty-three elbows that had been followed for at least two years, twelve (52 per cent) had an excellent result, eight (35 per cent) had a good result, and three (13 per cent) had a poor result.
患有幼年类风湿性关节炎的患者，由于多个关节出现严重僵硬和疼痛，常在非常年幼时就前来就诊。虽然全肘关节置换术可能适用于这些患者，但由于软组织挛缩以及这些患者的骨骼和髓腔极小，该手术操作困难。鉴于文献中关于此手术的信息很少，我们试图通过评估19例（24个肘关节）接受全肘关节置换术治疗的幼年类风湿性关节炎患者来了解其长期疗效。术后平均7.4年（范围为2至14年），梅奥肘关节功能评分平均从术前的31分（范围为5至55分）提高到90分（范围为55至100分）。在最近一次随访评估中，23个可评估的肘关节中有22个（96%）几乎没有疼痛或完全不痛，但活动范围的改善不太稳定。平均屈曲弧度仅从术前的63度提高到术后的90度；术后平均屈曲弧度从35度开始，可额外屈曲至125度。对术前已强直的4个肘关节进行检查发现，术后平均弧度为73度，对20个未受疾病限制的同侧手腕进行评估发现，旋前和旋后功能得以保留。平均功能评分从术前的9分（范围为0至25分）提高到术后的23分（范围为15至25分）（p<0.001）。18个肘关节（78%）的功能对日常生活活动能力没有不利影响。共有13例并发症，包括1例围手术期死亡，累及24个肘关节中的12个。9例早期并发症中的7例，包括尺骨鹰嘴骨折、假体半脱位、肘关节僵硬和伤口愈合问题，导致了额外的手术，但在经过适当诊断和治疗后，并未对长期疗效产生不利影响。晚期并发症（无菌性松动、不稳定和衬套磨损）导致3例疗效不佳。在最近一次随访评估中，18个半限制性假体均无影像学证据显示松动。在随访至少两年的23个肘关节中，12个（52%）疗效极佳，8个（35%）疗效良好，3个（13%）疗效不佳。
