Background: 

When revision elbow arthroplasty is required in the presence of structural proximal ulnar bone loss and triceps insufficiency, structural ulnar bone-grafting and triceps reconstruction are both required to reconstruct the skeleton and to restore active extension. We have developed a technique utilizing a structural proximal ulnar allograft with its attached triceps as an allograft-prosthetic composite (APC) to provide reconstruction of the proximal ulnar bone and deficient extensor mechanism with the same allograft.

Methods: 

Between 2010 and 2017, the senior author performed 10 revision elbow arthroplasties using a proximal ulnar allograft with its intact triceps tendon allograft. The allograft ulna was combined with an ulnar component in an APC fashion, whereas the remaining triceps was repaired to the triceps allograft. Indications for a revision surgical procedure included aseptic loosening in 4 elbows, periprosthetic ulnar fracture with component loosening in 2 elbows, and the second stage of a 2-stage reimplantation in 4 elbows. Two elbows also required humeral APCs due to associated structural humeral bone loss. Postoperatively, all elbows were immobilized in extension for 6 weeks. The mean follow-up time was 45 months (range, 24 to 76 months).

Results: 

Revision elbow arthroplasty resulted in pain improvement in all elbows in a 10-point visual analog scale. The mean flexion-extension arc was 95°, the mean Mayo Elbow Performance Score was 76 points (range, 45 to 95 points), and the mean triceps strength score was 4. There were 6 reoperations: 3 for humeral loosening, 1 for deep infection, 1 for fracture of the ulnar allograft, and 1 for wound debridement and closure. For the 8 elbows with an intact ulnar reconstruction, no ulnar components were radiographically loose, and the ulnar graft was considered radiographically intact and healed in 8 elbows.

Conclusions: 

Reconstruction of the proximal part of the ulna and triceps in failed elbow arthroplasties with structural ulnar bone loss can be effectively accomplished using a structural proximal ulnar allograft as an APC with the preserved triceps tendon for the extensor mechanism reconstruction, but the procedure is associated with an expected high reoperation rate, as is the case in complex revision elbow arthroplasty.

Level of Evidence: 

Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.

中文翻译：

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修订肘关节置换术，使用近端同种异体三头肌同种异体移植治疗合并尺骨丢失和三头肌功能不全

背景： 

当在结构性近端尺骨丢失和三头肌功能不全的情况下需要翻修肘关节置换术时，结构性尺骨植骨和三头肌重建都需要重建骨架并恢复活动性伸展。我们已经开发出一种技术，该技术利用结构化的近端尺骨同种三头肌作为同种异体修复复合材料（APC），以重建同侧同种异体的尺骨近端骨和伸肌机制不足。

方法： 

在2010年至2017年之间，该资深作者使用近端尺骨同种异体三头肌腱同种异体移植进行了10次翻修肘关节置换术。同种异体尺骨以APC方式与尺骨组件结合，而其余的三头肌则被修复为同种三头肌。修订外科手术的适应症包括4个肘部的无菌性松动，2个肘部的假体周围尺骨骨折和2个肘部的松动，以及4个肘部的2期再植入的第二阶段。由于相关的肱骨结构性骨丢失，两个肘部也需要肱骨APC。术后，将所有肘部固定固定延长6周。平均随访时间为45个月（范围为24到76个月）。

结果： 

修订肘关节置换术以10点视觉模拟量表改善了所有肘部的疼痛。平均屈伸弧度为95°，平均Mayo肘关节成绩为76分（范围为45至95分），平均三头肌力量得分为4。再次手术6次：肱骨松动3次，深部松动1次感染，其中1个用于同种异体尺骨骨折，1个用于伤口清创和闭合。对于8具完整尺骨重建的肘部，没有尺骨成分在影像学上松动，并且认为8肘部的尺骨移植物在影像学上是完整的并且已经愈合。

结论： 

失败的肘关节置换术合并结构性尺骨丢失的尺骨和三头肌的近端部分的重建可以有效地完成，方法是使用结构化的近端尺骨同种异体移植作为保留保留的三头肌腱的APC进行伸肌机理重建，但是该过程与预期的高手术率，如复杂翻修肘关节置换术。

证据级别： 

治疗级别IV。有关证据水平的完整说明，请参见《作者说明》。