伴有僵/强直畸形的炎症性肘关节炎行半限制性人工全肘关节置换术的早期疗效  

The early effects of semi-constraint total elbow arthroplasty for stiff or ankylosed inflammatory arthritis in elbow

作　　者：姜军[1] 关振鹏[1] 张绍龙[1] 张卓[1] 裴征[1] 李云鹏[1] 

机构地区：[1]北京大学人民医院关节病诊疗研究中心,100044

出　　处：《中华关节外科杂志（电子版）》2011年第3期18-22,共5页Chinese Journal of Joint Surgery(Electronic Edition)

摘　　要：目的探讨对合并僵/强直畸形的炎症性肘关节炎患者行半限制性人工全肘关节置换的早期疗效。方法 2008年4月至2010年1月采用Coonrad-Morrey半限制型假体治疗肘部疾患7例(7肘),其中类风湿关节炎4例,银屑病性关节炎2例,肘关节骨关节炎1例;其中男2例,女5例;年龄41～65岁,平均49.75岁。结果 7例患者均获得随访,肘关节屈伸活动度由术前的52.5°(0°～75°)上升至术后的102.86°(80°～118°)(P<0.05);肘关节前臂旋前、旋后的活动范围由术前的71.25°(0°～120°)提高至115°(50°～150°)(P<0.05)。患者Mayo肘关节功能评分(MEPS评分)由术前的55.63分提高至术后的81.25分(P<0.05);3肘优,3肘良,1肘可,优良率85.7%。并发症:1例完全强直肘关节术后1周康复锻炼时出现肱骨内髁骨裂,石膏固定治疗后6周愈合,1肘术前即有尺神经支配区感觉减退,术后6个月尺神经支配区感觉部分恢复。结论对于合并僵/强直畸形的炎症性关节炎患者行半限制性人工全肘关节置换术的早期疗效较好,具有彻底矫正畸形、消除疼痛,改善肘关节功能的优点,但中长期疗效仍需进一步观察。Objective To discuss the early effectiveness of semi-constraint total elbow arthroplasty in the treatment of stiff or ankylosed inflammatory arthritis. Methods Seven total elbow replacement procedures were performed with Coonrad-Morrey semi-constraint prosthesis, from April, 2008 to January, 2010. There were four of the seven cases with rheumatoid arthritis, two with psoriatic arthritis, and one with osteoarthritis. Two of the seven patients were male, and the other five were female. The average age was 49.75 years old （ranging from 41 to 65 ）. Results At the latest follow-up, the average range of motion of the seven elbows was 102.86 degrees （ranging from 80 to 118 degrees） , while it was 52.5 degrees （ range, 0 - 75 degrees） preoperative （ P 〈 0. 05 ）. The average range of pronation to supination was 115 degrees （ranging from 50 to 150 degrees）, while it was 71.25 degrees （range, 0 - 120 degrees） preoperative （P 〈 0. 05 ）. Average Mayo Elbow Performance Score was 55.63 preoperative, and 81.25 postoperative （P 〈 0. 05 ）. There were excellent results in three elbows, good in three, and fair in one as for assessment. Split fracture of medial condylar occured in one ankylosed elbow during the postoperative rehabilitation. The fracture was healed with conseravation treatment. Six months postoperative, part of innervated restoration of ulnar nerve was found in the elbow with preoperative ulnar nerve paralysis. Conclusions semi-constraint total elbow arthroplasty is effective in the treatment of stiff or ankylosed inflammatory arthritis, which might correct deformity, relieve pain, and improve elbow function. However, mid-term and lone-term evaluations are still needed.

关 键 词：肘关节 关节炎 关节强直 关节成形术 置换 

分 类 号：R687.4[医药卫生—骨科学]