人工肘关节置换术治疗炎症性肘关节炎的临床效果及相关分析(英文)

Clinical outcome of using souter elbow arthroplasty in patient with inflammatory elbow arthritis

目的对应用Souter-Strathclyde假体行肘关节置换术治疗炎症性肘关节炎的的临床效果进行分析。方法1993至2000年间,共49例患者(51肘)在芬兰坦配雷大学医学院医院应用Souter-Strathclyde假体行全肘关节置换术。其中女43例,男16例,平均年龄61.7岁(31～78岁),临床评估参照Ewald评分系统。结果除1例患肘是牛皮癣性肘关节炎外,其余均为风湿性肘关节炎,平均病程为30年(10～43年),Larsen分级术前4级22肘,5级29肘,47肘应用非限制型Souter-Strathclyde假体,4肘应用半限制型假体。平均随访时间72个月(0.5～114个月)。所有患者最终随访时的肘关节功能得到明显提高,平均活动度由术前的伸32.8°-屈126.9°提高至伸25.2°-屈145.0°(P<0.05);Ewald评分由术前的平均46.7分提高至95.0分(P<0.05)。2例患者出现术后关节脱位,1例手术复位,另1例闭合复位后石膏固定;另外有1例患者因肱三头肌撕裂进行了手术修复;3例肱骨及桡骨假体周围出现骨吸收线。以再次翻修作为终点,假体5年生存率为98%,8年生存率为93%,临床功能优良率为95.5%。结论尽管炎症性关节炎会导致患者韧带松弛,容易感染,骨质破坏,一般情况较差,但是全肘关节置换术可以为炎症性肘关节炎患者带来良好的临床疗效。

Objective To assess the clinical and functional outcome of non-and semi-constrained Souter-Strathclyde primary total elbow joint arthroplasty in patients with arthritic joint destruction. Methods A consecutive series of 51 primary Souter elbow arthroplasties were performed at the Tampere University Hospital from 1993 to 2000. There were 43 female and 6 male patients with a mean age of 61.7 years （range 31-78）. Results Except one case was due to psoriatic arthropathy, all cases were diagnosed as rheumatoid arthritis. The average duration of the disease was 30 years （10-43）. Larsen grade for the radiographic elbow destruction was 4 in 22 cases, and 5 in 29 cases pre-operatively. Non-constrained components were used in 47 cases, and semi-constrained components in 4 cases. The average follow up time after the primary operation was 72 months （range 0.5-114 months）. The range of motion showed remarkable increase at the latest follow-up： the preoperative mean extension and flexion deficit were 32.8°and 126.9°respectively, post-operative mean extension and flexion deficit were 25.2°and 145.0° respectively （P0.05）. The Ewald score increased from the pre-operative value 46.7 （mean） to the post-operative 95.0 （mean） （P0.05）. Two patients had post-operative dislocation. One was treated operatively and the other was treated with closed reduction and immobilisation. There was also one patient with triceps avulsion treated operatively. Radiological loosening of both the humeral and ulnar components was seen in three patients. The total cumulative survival rates of the Souter elbow arthroplasty in 5 and 8 years after surgery were 98% and 93%, respectively. 95.5% of the patients subjectively evaluated their operated elbows as excellent or good. Conclusions These results suggest that total elbow joint arthroplasty can be used successfully in patients with arthritic joint destruction.