全肘关节成形术-为什么和如何

                               
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Elbow arthroplasty is a relatively infrequent orthopaedic procedure that can be performed in multiple ways according to the type of prosthesis that is used and the needs of the individual patient. In 2016, the Dutch Arthroplasty Register included approximately 400 elbow arthroplasties compared with more than 28,000 hip arthroplasties and more than 27,000 knee arthroplasties.

Joint arthroplasty is performed in patients after other solutions to obtain pain relief and improve function, such as conservative treatment using physiotherapy and analgesics and operative treatment such as (arthroscopic) joint debridement, have been tried. In patients with slight to moderate joint osteoarthritis and in young patients, these options are preferable because a patient may outlive an elbow replacement and these approaches increase the time before a replacement is necessary.

The planned patient-specific approach includes decisions regarding which implant to use and how to handle the triceps muscle and tendon during the approach. First, the implant choices are made on the basis of stability and extensiveness; that is, whether unlinked implants, which have less intrinsic stability, or linked implants, which have more intrinsic stability, should be used, and whether ulnohumeral joint replacement should be done with or without radiocapitellar joint replacement. For example, in heavily deteriorated rheumatic elbows with insufficient ligamentous stability, a linked prosthesis is most often chosen. Second, to allow proper visualization, the triceps tendon can be split, reflected, or lifted using an ulnar osteotomy. After removal of the diseased cartilage and preparation of the ulna, humerus, and radius, the prostheses are implanted according to implant-specific guidelines. In the videos accompanying this article, the implantation of a Latitude total elbow prosthesis (Tornier) is shown.

As with all arthroplasties, rehabilitation is necessary. The elbow is prone to develop contractures, which are prevented by having the patient avoid long-standing inactivity and wearing a cast.