应用全肘关节置换术治疗肘关节类风湿关节炎121例的中期疗效

Mid-term clinical outcomes of Coonrad-Morrey total elbow arthroplasty for 121 patients with rheumatoid arthritis

目的探讨应用Coonrad-Morrey假体行全肘关节置换术(TEA)治疗类风湿关节炎(RA)肘关节破坏的中期疗效及假体生存时间。方法回顾分析2009年2月至2018年7月上海中医药大学附属光华医院关节矫形外科应用Coonrad-Morrey假体行TEA治疗的RA肘关节破坏患者121例的临床资料。记录患者术前、术后6周、术后1年及末次随访肘关节功能活动度、Mayo肘关节功能评分(MEPS)及手术相关并发症的发生情况。通过术后即刻、术后1年及末次随访X线对假体松动情况进行影像学分析,以假体松动或翻修手术为结局事件,使用Kaplan-Meier生存分析方法评估假体生存时间。结果患者术前肘关节屈、伸角度分别为54.7°±12.7°和96.8°±17.4°,屈伸范围为33.4°±14.2°;内、外旋角度分别为46.8°±15.4°和44.8°±16.9°,旋转范围为74.4°±15.7°;MEPS评分为34.7±17.4。TEA术后6周,肘关节功能活动度为112.9°±14.8°,MEPS评分为92.6±14.7,均有明显改善(P<0.01)。但术后1年肘关节功能活动度为106.9°±22.6°,MEPS评分为87.9±10.2,略有下降。术后X线评估,115例双侧骨水泥填充量充足,3例填充量为临界水平,2例存在填充不足。总体并发症发生率为17.35%,包括术中骨折1例,术后尺神经麻痹5例,假体无菌性松动3例,肘关节不稳1例,肱三头肌无力2例,假体周围骨折2例,慢性疼痛综合征2例,感染4例,异位骨化1例。假体5年生存率为96.6%,10年生存率为82.8%。结论应用Coonrad-Morrey假体行TEA可以有效治疗RA肘关节破坏,显著改善肘关节功能,提升患者生活质量,获得良好的中期疗效及假体生存率。

Objective To investigate the mid-term outcomes of Coonrad-Morrey total elbow arthroplasty(TEA)for patients with rheumatoid arthritis(RA).Methods Clinical data of 121 patients with rheumatoid arthritis underwent TEA using Coonrad-Morrey prosthesis between February 2009 and July 2018 were retrospectively analyzed.Elbow functional activity,Mayo elbow function score and surgical-related complications were recorded before surgery,6 weeks after surgery,one year after surgery and last follow-up.Radiological analysis of prosthesis loosening were performed on X-ray immediately after surgery,one year after surgery and last follow-up.The clinical observation endpoint was prosthesis loosening or revision surgery.Kaplan-Meier survival analysis was used to estimate the time of prosthesis survival.Results The preoperative flexion and extension angles of the affected elbow were 54.7°±12.7°and 96.8°±17.4°,respectively.The range of flexion and extension was 33.4°±14.2°.The internal and external rotation angle were 46.8°±15.4°and 44.8°±16.9°,respectively and the rotation range was 74.4°.The MEPS score before operation was 34.7±17.4.Early follow-up at 6 weeks after surgery showed that the functional activity of the elbow joint and the MEPS score improved significantly(all P<0.01).Postoperative X-ray evaluation showed that bone cement were adequately filled in 115 cases,at critical levels in 3 cases and underfilled in 2 cases.The overall complication rate was 17.35%,including one case of intraoperative fractures,5 cases of ulnar nerve palsy,3 cases of aseptic loosening,one case of elbow instability,2 cases of triceps weakness and 2 cases of prosthetic fractures.The post-operative complications included 2 cases of chronic pain syndrome,4 cases of infection and one case of ectopic ossification.Survival analysis showed a 9-year no-revision rate of 96.6%and a 10-year no-revision rate of 82.8%.Conclusion TEA with Coonrad-Morrey prosthesis is effective for RA elbow and could obtain a good mid-term prognosis.