鹰嘴截骨入路人工全肘关节置换术的疗效研究

Effectiveness of total elbow arthroplasty via olecranon osteotomy approach

目的 探讨鹰嘴截骨入路人工全肘关节置换术(total elbow arthroplasty,TEA)的临床疗效。方法 2011年1月—2021年12月,采用鹰嘴截骨入路TEA治疗22例(25侧)肘关节疾病患者。男9例,女13例;年龄32~80岁,平均52.0岁。单侧肘关节19例,其中左侧12例、右侧7例;双侧肘关节3例。骨关节炎3例(3侧),类风湿性关节炎7例(9侧),创伤性关节炎6例(7侧),肱骨远端骨折4例(4侧),肘关节结核2例(2侧)。记录手术时间、术中出血量以及术后并发症发生情况,采用Mayo肘关节功能评分标准(MEPS)及关节活动度评价肘关节功能,影像学复查假体位置及截骨愈合情况。结果 手术时间53~120 min,平均90.6 min;术中出血量为10~200 mL,平均68.4 mL。术后切口均Ⅰ期愈合。22例患者均获随访,随访时间3.9~126.7个月,中位时间47.6个月。X线片复查示假体位置良好;截骨处均愈合,愈合时间79~98 d,平均86 d。末次随访时,22例患者MEPS评分为72~100分,平均91.6分;获优17侧,良7侧,一般1侧,优良率96%。肘关节活动度达屈曲98°~140°,平均119.7°;伸直5°~23°,平均13.9°;旋前70°~90°,平均83.3°;旋后63°~90°,平均79.4°。其中17例(20侧)术前无骨折及关节僵硬患者随访时间3.9~126.7个月,中位时间53.9个月;末次随访时,MEPS评分以及肘关节活动度均优于术前(P<0.05)。5例(5侧)术前骨折及关节僵硬患者随访时间12.0~124.2个月,中位时间40.1个月。末次随访时,MEPS评分为89~100分,平均91.2分,肘关节活动度均恢复。术后2例(2侧)出现尺神经症状,1例(1侧)发生假体周围骨折并翻修术后假体周围感染,取出肘关节假体。假体生存率96%,随访期间无假体松动发生。结论 经鹰嘴截骨入路行TEA术中视野暴露充分,能降低肱三头肌无力、尺神经损伤等并发症发生率,有效改善肘关节功能,获得满意疗效。

Objective To investigate the effectiveness of total elbow arthroplasty(TEA) via olecranon osteotomy approach.Methods Between January 2011 and December 2021,22 patients(25 sides) with elbow joint disease were treated with TEA via olecranon osteotomy approach.There were 9 males and 13 females with an average age of 52.0 years(range,32-80 years).The disease involved unilateral elbow joint in 19 cases,including 12 cases on the left side and 7 cases on the right side,and 3 cases with bilateral elbow joints.There were 3 cases(3 sides) of osteoarthritis,7 cases(9 sides) of rheumatoid arthritis,6 cases(7 sides) of traumatic arthritis,4 cases(4 sides) of distal humeral fracture,and 2 cases(2 sides) of elbow tuberculosis.The operation time,intraoperative blood loss,and postoperative complications were recorded.The Mayo Elbow Performance Score(MEPS) and range of motion(ROM) were used to evaluate the elbow joint function,and imaging was used to review the position of the prosthesis and the healing of the osteotomy.Results The operation time ranged from 53 to 120 minutes(mean,90.6 minutes);intraoperative blood loss ranged from 10 to 200 mL(mean,68.4 mL).All incisions healed by first intention.All patients were followed up 3.9-126.7 months,with a median time of 47.6 months.At last follow-up,the MEPS scores of 22 patients ranged from 72 to 100(mean,91.6);the elbow joint function was rated as excellent in 17 sides,good in 7 sides,and fair in 1 side,with an excellent and good rate of 96%.Elbow joint ROM was 98°-140° in flexion(mean,119.7°),5°-23° in extension(mean,13.9°),70°-90° in anterior rotation(mean,83.3°),and 63°-90° in posterior rotation(mean,79.4°).The follow-up time of 17 patients(20 sides) without fracture and joint stiffness before operation was 3.9-126.7 months,with a median time of 53.9 months;at last follow-up,the MEPS score and the elbow joint ROM were significantly better than those before operation(P<0.05).The follow-up time of 5 patients(5 sides) with fracture and joint stiffness before operation was 12.0-124.2 months,with a median time of 40.1 months.At last follow-up,MEPS scores ranged from 89 to 100(mean,91.2),and elbow joint ROM restored.Two cases(2 sides) developed ulnar nerve symptoms after operation,and 1 case(1 side) suffered from periprosthetic fracture and periprosthetic infection after revision,and the elbow prosthesis was removed.The prosthesis survival rate was 96%.During follow-up,no prosthesis loosening occurred.Conclusion The intraoperative visual field exposure of TEA via the olecranon osteotomy approach is sufficient,which can reduce the incidence of complications such as triceps weakness and ulnar nerve injury,effectively improve the function of the elbow joint,and obtain satisfactory effectiveness.