背景:Pyrocarbon有望成为桡骨头关节成形术(RHA)的最佳材料选择,因为其弹性模量与桡骨骨干相当,因此提供了更高的生物相容性。主要目的是确定与使用这些假体相关的并发症和翻修率。次要目标是评估PyrocarbonRHA的临床和放射学结果。
目的:PyrocarbonRHA具有良好的临床和放射学结果,并发症和修订较低。
方法:使用OvidMEDLINE和Embase数据库来搜索关于使用Pyrocarbonradial头假体的RHA结果和并发症的研究。系统评价是根据PRISMA指南设计的,纳入的研究使用MINORS工具进行评估。评估并发症和RHA翻修率。使用PROM(如MEPI,DASH和BMS),术后运动范围(使用测角仪)和握力(使用测力计)。术后放射学结果,如假体周围的透明度,桡骨颈骨质溶解,射电-行星全等,球座侵蚀,使用X光片报告过填充/未填充和骨关节炎。
结果:共有12项研究报告了353例接受PyrocarbonRHA的患者纳入了该综述。研究中患者的平均年龄为47至54岁,其中50.5%为男性。大多数radial头置换用于急性创伤(87.5%),其余用于关节炎(1.7%)和创伤后遗症(10.8%)。所选研究的平均随访期为18至110个月,所有研究的最低随访期为12个月。模块化热解碳(MoPyC,Tornier™)是十项研究中的首选植入物,而两项研究使用了AscensionPyrocradial头(AscensionOrthopaedics™)。10项研究显示平均MEPI为75.5至96。平均扩展缺陷从6到19度不等,从120到140度的平均屈曲,平均内旋从71到87度,平均外旋从63到85度。相对握力范围为对侧肢体的69%至96%。由于植入物相关原因(假体内解离,假体骨折,假体周围松动,射电头球半脱位和肘部填充不足/填充过多)为6.8%(24/353)。在不同的研究中,有10%至100%的患者报告了径向应力屏蔽和假体周围的透明度,但导致翻修的症状性植入物松动仍然很少(2%,7/353)。据报道,在81%至100%的病例中,有放射性头状层一致性,而头状层侵蚀的范围为0%至89%。Pyrocarbon植入物的特定并发症包括头颈部假体内脱钩(1.1%)和热解碳头骨折(0.9%)。总的来说,5.7%的病例因非RHA相关原因再次手术。
结论:热解碳RHA显示出良好的功能结果,运动范围和低修订率。这与这篇综述的工作假设是一致的。然而,pyrocarbonradial头植入物具有特定于植入物的并发症,例如pyrocarbonradial头骨折和茎与头之间的假体内脱钩。尽管有希望的体外生物力学特性,头球磨损仍然是焦碳RHA的常见发现。尽管有这些因素,焦碳桡骨头植入物是桡骨头成形术的可行选择。
方法:II;系统评价。
BACKGROUND: Pyrocarbon promises to be an optimal material choice for radial head arthroplasty (RHA) due to an elastic modulus comparable to the radial diaphysis and thus providing higher biocompatibility. Primary objective was to determine the complications and revision rates related to the usage of these prostheses. The secondary objective was to assess the clinical and radiological outcomes of
Pyrocarbon RHAs.
OBJECTIVE: Pyrocarbon RHAs have good clinical and radiological outcomes with low complications and revisions.
METHODS: Ovid MEDLINE and Embase databases were used to search for studies on outcomes and complications of the RHAs using Pyrocarbon radial head prostheses. The systematic review was designed in accordance with the PRISMA guidelines and included studies were appraised using the MINORS tool. Complications and RHA revision rates were assessed. Functional outcomes were reviewed using PROMs (like MEPI, DASH and BMS), post-op range of motion (using goniometer) and grip strength (using the dynamometer). Postoperative radiological outcomes like peri-prosthetic lucency, radial neck osteolysis, radio-capitellar congruence, capitellar erosion, overstuffing/understuffing and osteoarthritis were reported using radiographs.
RESULTS: A total of 12 studies cumulatively reporting 353 patients who underwent Pyrocarbon RHAs were included in the review. The mean age of patients across the studies ranged from 47 to 54 years of which 50.5% were males. The majority of radial head replacements were done for acute trauma (87.5%) with the remainder done for arthritis (1.7%) and trauma sequelae (10.8%). Mean follow-up period in the selected studies ranged from 18 to 110 months with minimum follow-up across all studies being 12 months. Modular Pyrocarbon (MoPyC, Tornier™) was the implant of choice in ten studies while two studies used the Ascension
Pyrocarbon radial head (Ascension Orthopaedics™). Ten studies demonstrated mean MEPI ranging from 75.5 to 96. Mean extension deficit ranged from 6 to 19 degrees, mean flexion from 120 to 140 degrees, mean pronation from 71 to 87 degrees and mean supination from 63 to 85 degrees. Relative grip strength ranged from 69 to 96% of the contralateral limb. Revisions due to implant-related reasons (intra-prosthetic dissociation, prosthetic fracture, peri-prosthetic loosening, radio-capitellar subluxation and understuffed/overstuffed elbow) was 6.8% (24/353). Radial stress shielding and peri-prosthetic lucency was reported in 10 to 100% of patients across different studies but symptomatic implant loosening leading to revision remained rare (2%, 7/353). Radio-capitellar congruence was reported in 81% to 100% cases while capitellar erosion ranged from 0% to 89%. Pyrocarbon implants specific complications included head-neck intra-prosthetic decoupling (1.1%) and
pyrocarbon head fractures (0.9%). In total, 5.7% cases underwent re-surgery due to non-RHA related reasons.
CONCLUSIONS: The pyrocarbon RHA shows good functional outcome, range of motion and low revision rates. This aligns with the working hypothesis of this review. However,
pyrocarbon radial head implants have implant-specific complications like
pyrocarbon radial head fractures and intra-prosthetic decoupling between stem and head. Despite promising in vitro biomechanical properties, capitellar wear is still a common finding with pyrocarbon RHAs. Despite these factors, pyrocarbon radial head implants are a viable option for radial head arthroplasty.
METHODS: II; Systematic review.