定制铰链型关节假体在肘关节功能重建中的应用

Hinge prosthesis for elbow joint functional reconstruction

目的:在肿瘤切除之后的保肢选择方式中,肘关节假体置换是一种较好的重建方式。回顾性分析了定制铰链型假体治疗肘关节周围肿瘤的材料和宿主反应及并发症。方法:1997-06/2006-06北京大学人民医院对25例肘关节周围肿瘤患者实施了肿瘤切除后应用国产定制铰链型关节假体置换。男17例,女8例,年龄9～71岁,平均35.72岁。发病部位:肱骨远端18例,尺骨近端7例。采用的假体为春立正达公司定制铰链式人工肘关节假体。肱骨部分根据不同情况采用生物固定或者骨水泥固定,尺骨柄为螺纹,螺旋式进入尺骨髓腔。25例均接受随访12～107个月,观察有无假体松动、感染等生物相容性反应及并发症。根据Mayo肘关节功能评分系统评估患者的功能恢复情况。结果:①25例患者均获得随访,平均随访28.6个月,20例患者存活,5例死亡。没有假体松动、感染或者局部复发的材料和宿主反应发生。②置入后尺神经损伤2例,假体肱骨柄松动1例,假体轴心断裂脱位1例,肱骨外髁骨折1例。③肘关节的平均屈伸范围由26°提高到81°(46°～108°)。疼痛评分从置换前平均(3.0±0.6)分降至置换后平均(2.0±0.3)分。结论:国产定制铰链型肘关节与宿主有良好的生物相容性,可以恢复肘关节功能,减轻疼痛,置入后并发症较少。

AIM： Elbow arthroplasty is a good reconstruction approach after resection of tumor. In this study, we retrospectively analyzed response of host and material and complications of the total elbow arthroplasty with hinge prosthesis for peri-elbow tumor. METHODS： Between June 1997 and June 2006, 25 patients underwent total elbow arthroplasty using hinge prosthesis （made in China） after resection of tumors, involved 17 males and 8 females with average age of 35.72 years （range, 9-71 years）. There were 18 cases with tumors in distal humerus, and 7 in proximal ulna. The hinge prosthesis was product of Beijing Chunli Zhengda Technology Co., Ltd. Humeral bone was fixed by biological method or cement. Ulnar bone stem was thread and rotated into uluar bone cavity. All patients were followed up for 12-107 months to observe prosthesis loosening, infection or other biocompatible responses and complication. The function recovery of patients was evaluated by Mayo elbow joint scoring system. RESULTS： （1）All 25 patients were followed up with mean time of 28.6 months. Twenty patients survived, and the others were dead. No prosthesis loosening, infection or responses of host to materials were found. （2）Ulnar nerve injury was found in 2 cases, aseptic loosening of humeral prosthetic stem found in 1 case, dislocation found in 1 case, and humeral lateral condylar fracture in 1 case. （3）Mean elbow motion from extension to flexion improved from 26° to 81° （range, 46° 108° ）.The mean scores of Mayo pain system decreased from （3.0±0.6） to （2.0±0.3） points. CONCLUSION： This hinge prosthesis of elbow joint shows good biocompatibility to host, and can relieve pain, improve elbow joint function, and reduce postoperative complication.