The Lateral Para-Olecranon Approach for Total Elbow Arthroplasty
The Lateral Para-Olecranon Approach for Total Elbow Arthroplasty
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DOI：
10.1016/j.jhsa.2013.07.029
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发表时间：
2013-11-01
影响因子：
1.9
通讯作者：
King, Graham J. W.
中科院分区：
文献类型：
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作者：
Studer, Alexis;Athwal, George S.;King, Graham J. W.
目的探讨经鹰嘴旁外侧入路行全肘关节置换术的可行性，并与经肘关节旁入路和经肱三头肌劈开入路进行比较。平均随访时间为54个月（范围，12-105个月）。在28例类风湿性关节炎肘关节中，17例采用肱三头肌劈开入路，6例采用外侧鹰嘴旁入路，5例采用肘关节旁入路。在9例骨折病例中，5例患者接受了外侧鹰嘴旁入路，4例患者接受了眶旁入路。比较了所有3种入路的伸展强度、活动范围、肘关节功能（马约肘关节性能指数）和与三头肌功能不全相关的并发症。此外，本发明还提供了一种方法，结果类风湿性关节炎患者经外侧鹰嘴旁入路植入假体后，肱三头肌的伸展力矩较健侧肘关节为好（20 +/- 8 N-m），与肱三头肌分离（13 +/- 4 N-m）或旁正中入路（12 +/- 6 N-m）相比。在骨折组中，替代肘关节的伸展强度与对侧正常肘关节的paratrachial和外侧para-olecranongroups.Conclusions外侧para-olecranon方法避免了肱三头肌肌腱脱离和修复鹰嘴，从而降低了肱三头肌功能不全的风险，同时保持更好的伸展强度相对于肱三头肌分裂的方法。版权所有（C）2013美国手外科学会。All rights reserved.
Purpose To describe and evaluate the lateral para-olecranon approach for total elbow arthroplasty and to compare it with the paratricipital and triceps splitting approaches.Methods A total of 34 patients who underwent total elbow arthroplasty were evaluated: 25 with rheumatoid arthritis (28 elbows) and 9 with fractures. The average duration of follow-up was 54 months (range, 12-105 mo). Of the 28 elbows with rheumatoid arthritis, 17 underwent a triceps splitting approach, 6 a lateral para-olecranon, and 5 a paratricipital approach. Of the 9 fracture cases, 5 patients underwent a lateral para-olecranon and 4 a paratricipital approach. Extension strength, range of motion, elbow function (Mayo Elbow Performance Index), and complications related to triceps insufficiency were compared for all 3 approaches. In addition, we compared triceps strength after lateral para-olecranon and paratricipital approaches with the contralateral healthy elbow in the 9 fracture cases.Results Patients with rheumatoid arthritis had better extension torque when the prosthesis was implanted through the lateral para-olecranon approach (20 +/- 8 N-m) compared with the triceps splitting (13 +/- 4 N-m) or paratricipital approaches (12 +/- 6 N-m). In the fracture group, the extension strength of the replaced elbow was similar to the contralateral normal elbow in both the paratricipital and lateral para-olecranon groups.Conclusions The lateral para-olecranon approach avoids triceps tendon detachment from and repair to the olecranon, thereby reducing the risk of triceps insufficiency while maintaining better extension strength relative to a triceps splitting approach. Copyright (C) 2013 by the American Society for Surgery of the Hand. All rights reserved.