背景:本研究旨在探讨尺骨鹰嘴截骨入路和Bryan-Morrey入路在全肘关节置换术(TEA)中的临床疗效。
方法:在这项回顾性研究中,49例肘部疾病患者接受TEA治疗。共22例经尺骨鹰嘴截骨入路TEA患者作为A组,通过Bryan-Morrey方法进行TEA的27例患者被指定为B组,男性22例,女性27例;年龄32至82岁,平均年龄62岁。单侧肘关节44例,其中左侧27例,右侧17例,双侧肘关节5例。有6例骨关节炎(7侧),类风湿性关节炎18例(22侧),14例创伤性关节炎(14侧),肱骨远端骨折7例(7侧),肘关节结核4例(4侧)。对于每个小组,我们记录了手术时间,术中出血,肘部屈曲,扩展,内旋,仰卧起坐,术后并发症发生率,和手术后的梅奥肘部表现评分(MEPS)。
结果:A组的手术时间和术中出血量少于B组。[53-120分钟[70(62.5,78)分钟]vs64-105分钟[77(73,87)分钟],10-200毫升[50(20,90)毫升]vs5-250毫升[100(50,150)毫升],P<0.028]。肘部屈曲,内旋活动,A组MEPS评分高于B组,[(121±12)°对(112±10)°,85(85,85)°vs80(77,85)°,(94±3)点对(91±4)点,P<0.036],而两组的肘部伸展和旋后活动和并发症发生率均无统计学意义。
结论:与Bryan-Morrey方法相比,TEA的尺骨鹰嘴截骨术提供了足够的可视化,节省手术时间,减少出血,提供更好的屈曲活动,有效改善肘部功能,并取得满意的临床疗效。
BACKGROUND: This study aims to investigate the clinical efficacy of the olecranon osteotomy approach and the Bryan-Morrey approach in total elbow arthroplasty (TEA).
METHODS: In this retrospective study, 49 patients with elbow disease were treated with TEA. A total of 22 patients with TEA by olecranon osteotomy approach were designated as group A, and 27 patients with TEA by Bryan-Morrey approach were designated as group B. There were 22 males and 27 females, aged 32-82 years with a mean age of 62 years. There were 44 cases of unilateral elbow joint, including 27 cases on the left elbow and 17 cases on the right elbow, and 5 cases of the bilateral elbow joint. There were 6 cases of osteoarthritis (7 elbows), 18 cases of rheumatoid arthritis (22 elbows), 14 cases of traumatic arthritis (14 elbows), 7 cases of distal humeral fractures (7 elbows), and 4 cases of elbow tuberculosis (4 elbows). For each group, we recorded the operative time, intraoperative bleeding, elbow flexion, extension, pronation, supination, postoperative complication rates, and Mayo Elbow Performance Score after surgery.
RESULTS: Operative time and intraoperative bleeding were less in group A than in group B (53-120 min [70 (62.5, 78) min] vs. 64-105 min [77 (73, 87) min], and 10-200 ml [50 (20, 90) ml] vs. 5-250 ml [100 (50, 150) ml], P < .028). The elbow flexion, pronation activity, and Mayo Elbow Performance Score were higher in group A than in group B, [(121 ± 12)° vs. (112 ± 10)°, 85 (85,85)° vs. 80 (77,85)°, and (94 ± 3) points vs. (91 ± 4) points, P < .036], while elbow extension and supination activity and complication rates were not statistically significant in either group.
CONCLUSIONS: Compared to Bryan-Morrey approach, the olecranon osteotomy approach to TEA provides adequate visualization, saves operative time and reduces bleeding, provides better flexion activity, effectively improves elbow function, and achieves satisfactory clinical outcomes.