total elbow replacement

Total elbow arthroplasty is used to restore elbow joint function. There are many types of artificial elbow joints, and the effect is not certain. In general, there is not much bone destruction and joint stability is suitable for non-restrictive (surface) elbow joint replacement. Elbow joint capsules, ligament injuries, bone defects, muscle atrophy are suitable for semi-restricted prostheses. Coonrad-Morrey artificial elbow replacement is now introduced as a representative surgery. The joint is a semi-restricted hinged joint, and the shaft is made of titanium and high molecular polyethylene. According to the biomechanics of the elbow joint, the improved version has a 7° longitudinal axis rotation and a slight lateral movement, that is, a certain relaxation to counteract the effect of part of the external force, which can reduce the occurrence of looseness. Treatment of diseases: traumatic arthritis elbow joint tonic rheumatoid arthritis Indication The purpose of elbow joint replacement is to restore elbow joint function by relieving pain, restoring movement and stability. 1. Elbow joint replacement can be performed when rheumatoid arthritis medical treatment, synovectomy, and humeral head resection are not likely to improve elbow pain and function. 2. The elbow joint is stiff. 3. Traumatic arthritis. 4. Elbow arthroplasty failed. Contraindications 1. Infection. 2. The shoulder joint is strong and straight. 3. Neurogenic osteoarthrosis. 4. Flexion and extension of the elbow muscles. 5. Elbow deformity without pain. Different types of artificial elbow joints also have their own special contraindications. If there is a large amount of bone defect in the elbow, it is not advisable to perform an elbow joint replacement. Preoperative preparation 1. Understand the extent of pain to determine surgical indications. 2. According to the X-ray film and other image data, select the appropriate artificial elbow joint. 3. Preoperative intravenous antibiotics to prepare the skin. Surgical procedure 1. More use of the posterior medial approach of the elbow joint. Protect the ulnar nerve. Carefully free the triceps and elbow muscles, together with the periosteum, detach the triceps tendon from the olecranon, maintain the integrity between the triceps and periosteum, open to the lateral or medial side, revealing the distal radius, proximal ulna and humerus Small head. 2. Saw the middle section of the tibial block and use a grinding drill to open the medullary cavity at the top of the olecranon. After the medullary cavity is enlarged, an alignment stem is inserted and a cutting block is placed. Place the side arm of the test piece on the small head of the humerus and measure the depth of the bone. Referring to the test piece, the trochlear and the humeral head are removed until the edge of the prosthetic specimen can be embedded in the gap between the humerus and the upper iliac crest. Scrape a small amount of cancellous bone at the proximal and external iliac crest and proximal humerus to match the prosthesis with the osteotomy surface and leave a gap between the cement. 3. Drill the proximal medullary cavity and enlarge the medullary cavity. Carefully remove the subchondral bone around the coronoid process. 4. Insert the artificial elbow joint specimen and check the elbow flexion and extension range. If there is no obvious impact on the small head of the humerus, it may not be removed. Remove the test piece, rinse the medullary cavity and dry. 5. Extremely flexing the elbow joint, filling the bone cement into the ulnar and iliac bone marrow cavity, and cutting the bone into a 1.5cm×1.0cm×0.3cm bone block, longitudinally placed under the periosteum of the lower end of the humerus, to the humerus and the medullary cavity. Insert the combined artificial elbow joint handle at the same time. The graft bone is embedded under the anterior wing of the tibial prosthesis. The prosthesis is inserted into the humerus and the medullary cavity. Extend the elbow position until the bone cement solidifies. 6. Rinse the incision, place the negative pressure drainage tube, advance the ulnar nerve, and repair the triceps and ligaments. complication There are many complications after artificial elbow joint replacement, the incidence rate is 30% to 40%. In addition to infections, nerve damage, and fractures, there are mainly: 1. Tibial prosthesis loosening 7% semi-restricted artificial elbow joint needs to be repaired, resected or fused due to loosening of the humeral prosthesis. 2. Instability mainly occurs in unrestricted artificial elbow joints. The 9% unrestricted elbow joint was thus refurbished.