上海交通大学学报（医学版）

上海交通大学学报（医学版）

• 论著（临床研究） • 上一篇    下一篇

定制型限制性全肘关节假体置换8例报告

何方舟，张伟滨，沈宇辉   

  1. 上海交通大学 医学院附属瑞金医院骨科，上海 200025
  • 出版日期:2016-08-29 发布日期:2016-08-31
  • 通讯作者: 沈宇辉，电子信箱：yuhuiss@163.com。
  • 作者简介:何方舟（1991—），男，博士生；电子信箱：hfzxyz@126.com。
  • 基金资助:

    上海市教育委员会高峰高原学科建设计划（20152204）

A report on 8 cases of total elbow arthroplasty with customized constrained elbow prosthesis

HE Fang-zhou, ZHANG Wei-bin, SHEN Yu-hui   

  1. Department of Orthopaedics, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200025, China
  • Online:2016-08-29 Published:2016-08-31
  • Supported by:

    Shanghai Municipal Education Commission—Gaofeng Clinical Medicine Grant Support，20152204

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摘要：

目的·评价定制型限制性全肘关节假体治疗肘关节难治性破坏性病变的术后早期临床疗效，分析手术技术要点。方法·2009年12月—2015年6月，利用定制型限制性肘关节假体行全肘关节置换术治疗难治性肘关节破坏性病变8例（组织细胞肉瘤伴病理性骨折、恶性周围神经鞘瘤、骨巨细胞瘤、纤维结构不良、纤维结构不良继发动脉瘤样骨囊肿、绒毛结节性滑膜炎、慢性滑膜炎、血友病性关节病伴病理性骨折各1例）。术前Mayo肘关节功能评分：<60分6例，60～74分1例，75～89分1例。手术采取肘关节后侧入口，所有患者术中安装假体后肘关节伸屈达到正常，术中尺神经前置，术后2周开始伸屈功能锻炼。术后评估临床疗效及影像学变化。结果·术后即刻影像学评估：未发生假体柄穿出尺骨，骨水泥合适，假体稳定性良好，无感染发生，无血管损伤，无桡神经损伤。1例术后早期尺神经感觉麻木，2周后好转，合并术后肘关节活动不稳定。平均随访时间为21.6个月；随访Mayo肘关节功能评分：60～74分1例，75～89分2例，>90分5例；影像学评估：假体均在位，无松动表现，无假体断裂。患者主观满意度高。结论·定制型限制性肘关节假体置换术是治疗肘关节难治性破坏性病变的一种可靠的方法。手术要点是保护尺桡神经、完整切除病变和尺骨侧假体设计。假体安装植入技术是避免并发症的关键点之一。

关键词: 肘关节, 骨肿瘤, 肘关节假体, 人工关节

Abstract:

Objective · To evaluate the early stage postoperative clinical efficacy of total elbow arthroplasty with customized constrained elbow prosthesis for the treatment of refractory destructive elbow diseases and analyze technical essentials of the operation. Methods · From Dec. 2009 to Jun. 2015, eight patients with refractory destructive elbow diseases underwent the total elbow arthroplasty with customized constrained elbow prosthesis (histiocytosarcoma with pathological fracture, malignant peripheral nerve sheath tumor, giant cell tumor, fibrous dysplasia, fibrous dysplasia with secondary aneurysmal bone cyst, villonodular synovitis, chronic synovitis, and hemophilic arthropathy with pathological fracture, one each). Preoperative Mayo Elbow Performance Index scores were <60 points in 6 patients, 60-74 points in 1 patient, and 75-89 points in 1 patient. The elbow posterior approach and ulnar nerve subcutaneous anterior transposition were performed and all patients achieved normal extension and flexion after arthroplasty. The extension and flexion exercise began 2 weeks after operation. The clinical efficacy and radiographic changes were evaluated. Results · The immediate postoperative radiographic evaluation showed no prosthesis handle pull-through failure, proper bone cement, stable prostheses, no infection, and no vessel and radial nerve injuries. The cubital nerve numb was seen in one patient and recovered after 2 weeks. This patient also had elbow instability after operation. The average follow-up period was 21.6 months. Mayo Elbow Performance Index scores during follow-up were 60-74 points in 1 patient, 75-89 points in 2 patients, and >90 in 5 patients. The radiographic evaluation showed that all prostheses were in position without looseness or fracture. The subjective satisfaction of patients was high. Conclusion · The total elbow arthroplasty with customized constrained elbow prosthesis is a reliable approach to treat refractory destructive elbow diseases. The technical essentials are ulnar and radius nerve protection, total resection of lesions, and ulnar prosthesis design. The prosthesis installation skill is a key point for avoiding complications.

Key words: elbow joint, bone neoplasms, elbow prosthesis, artificial joint