应用Coonrad-Morrey假体翻修6例类风湿关节炎肘关节成形术后假体无菌性松动的早期疗效  

Early clinical outcome of Coonrad-Morrey revision prosthesis in treatment of elbow aseptic loosening after total elbow arthroplasty in 6 patients with rheumatoid arthritis

作　　者：解骏 凌芸 高晨鑫 康冰心 许辉 邱国伟 肖涟波 Xie Jun;Ling Yun;Gao Chenxin;Kang Bingxin;Xu Hui;Qiu Guowei;Xiao Lianbo(Department of Joint Orthopedics, Guanghua Hospital Affiliated to Shanghai University of Traditional Medicine, Shanghai 200052, China)

机构地区：[1]上海中医药大学附属光华医院关节矫形外科,200052

出　　处：《骨科临床与研究杂志》2020年第6期360-365,共6页Journal Of Clinical Orthopedics And Research

基　　金：上海市卫生健康委员会重点项目-上海市临床重点专科建设(shslczdzk04801);上海中医药大学海外中医中心人才培养项目(2017040);上海中医药大学自然科学基金(18LK077)。

摘　　要：目的探讨应用Coonrad-Morrey假体翻修治疗类风湿关节炎(RA)全肘关节成形术(TEA)后假体无菌性松动患者的早期临床效果。方法回顾分析2009年1月至2018年12月应用Coonrad-Morrey肘关节假体翻修治疗的因RA接受TEA后假体无菌性松动患者6例临床资料。采用Mayo肘关节评分(MEPS)和疼痛视觉模拟评分(VAS)对术前和术后患肘活动度以及患者静息和活动状态疼痛程度进行评价。术后定期随访并复查肘关节正侧位X线,对假体是否存在松动、是否存在骨折以及关节周围骨和骨溶解情况进行评估。对术前和术后评价指标进行比较。采用SPSS 19.0软件对数据进行处理。结果6例患者均为女性;年龄(60.5±9.0)(48~75)岁。术后随访时间(15±4.6)(12~24)个月。术前与术后MEPS评分分别为(34.2±12.1)(25~60)分和(75.8±12.1)(65~90)分,VAS静息疼痛评分分别为(5.0±1.0)(4~7)分和(1.5±0.5)(1~2)分,VAS运动疼痛评分分别为(8.1±0.6)(7~9)分和(3.5±0.8)(2~4)分,差异均有统计学意义(均P<0.05);术后患肘稳定性较术前得到改善;术后患肘屈伸活动度和旋转活动度与术前差异均无统计学意义(P>0.05);术后出现肘关节感染、肱骨髁上骨折和尺神经一过性损伤各1例,未出现假体再松动。患者满意度为满意或中度满意。结论应用Coonrad-Morrey假体翻修治疗RA患者TEA后假体无菌性松动可获得令人满意的早期结果,但可能存在较高的并发症发生率。Objective To evaluate the early clinical outcome of Coonrad-Morrey revision prosthesis in treatment of elbow aseptic loosening after total elbow arthroplasty(TEA)in 6 patients with rheumatoid arthritis(RA).Methods Data of 6 patients with RA underwent TEA revision using Coonrad-Morrey prosthesis for aseptic loosening were retrospectively analyzed.Mayo Elbow Performance Score(MEPS)and Visual Analogue Scale(VAS)score were used to evaluate preoperative and postoperative range of motion(ROM)of affected elbow and patient's pain at rest and activity.Regular follow-up and reexamination of X-ray after operation were conducted to observe whether the prosthesis was loosened,whether there were fractures and osteolysis around the prosthesis.Software of SPSS 19.0 was used to process the data.Results All the 6 patients were female and aged(60.5±9.0)(48-75)years.The average duration of follow-up was(15±4.6)(12-24)months.The preoperative and postoperative MEPS scores were 34.2±12.1(25-60)and 75.8±12.1(65-90),and the preoperative and postoperative rest VAS scores were 5.0±1.0(4-7)and 1.5±0.5(1-2),the preoperative and postoperative active VAS scores were 8.1±0.6(7-9)and 3.5±0.8(2-4),respectively,and the differences were all statistically significant(all P<0.05).The stability of affected elbows were improved after operation.There were no statistically significant difference between postoperative and preoperative range of motion of affected elbows(P>0.05).The postoperative complications included infection in one case,supracondylar fracture of the humerus in one case and ulnar nerve transient injury in one case.All patients were satisfied with the result of the revision surgery.Conclusion TEA revision using Coonrad-Morrey revision prosthesis could achieve satisfactory early clinical results and however,there may be a higher incidence of complications.

关 键 词：关节成形术 置换 肘 关节炎 类风湿 假体失效 肘关节假体 手术后并发症 手术中并发症 

分 类 号：R68[医药卫生—骨科学]