Ergebnisse des Ellbogengelenkersatzes bei rheumatischer Destruktion

Zusammenfassung

Einleitung: Die Destruktion des Ellbogengelenkes tritt bei rheumatischen Gelenkerkrankungen meist erst nach längerem Verlauf oder bei den mutilierenden Formen auf. Zur Behandlung der dadurch verursachten Schmerzen und Funktionsstörung werden der Gelenkersatz oder die Resektionsarthroplastik empfohlen. Material und Methode: Bei 22 Rheumatikern wurden nach im Mittel 19,4 Jahren ihrer rheumatischen Erkrankung 26 Ellbogenprothesen implantiert, davon eine Wechseloperation. 18 Ellenbogengelenke konnten nach 35,2 Monaten anhand des Mayo Clinic Performance Scores (MCPS) nachuntersucht werden. Ergebnis: Intraoperativ trat eine Fraktur eines Epicondylus auf, die ohne negative Auswirkungen auf das Ergebnis durch Osteosynthese behandelt wurde. Es gab keine revisionspflichtigen Infekte. Der Schmerz verbesserte sich bei 17/18 Patienten. Der Bewegungsumfang betrug postoperativ bei allen Patienten mehr als 100°, wobei im Mittel ein Streckdefizit von ca. 20° verblieb. Alle nachuntersuchten Gelenke waren stabil. Die Aktivitäten des täglichen Lebens verbesserten sich zwischen 61 - 94 %. Im MCPS-Gesamtscore wurden die Ergebnisse in 72 % als exzellent und in 28 % als gut eingeschätzt. Alle Patienten waren mit dem Operationsergebnis zufrieden. Schlussfolgerung: Bei ausgewählten Indikationen führt der Ersatz des rheumatischen Ellbogengelenkes zu funktionell sehr guten und guten Ergebnissen mit hoher Patientenzufriedenheit.

Abstract

Introduction: In rheumatoid patients destruction of the elbow joints occurs late in the natural course or in mutilating forms. Pain and loss of function are treated by joint replacement or resection arthroplasty. Materials: 26 joint replacements (including one revision) have been done in 22 rheumatoid patients after a disease duration of 19,4 years mean. 18 joints could be evaluated 35,2 months later according to the Mayo Clinic Performance Score (MCPS). Results: One fracture of the epicondylus was treated by osteosynthesis without negative impact on the outcome. There have been no revisions due to infection. Pain was improved in 17/18 patients. ROM was more than 100° in all patients, leaving an extension lag of 20° mean. All examined joints were stable. ADL improved between 61 - 94 %. According to the MCPS total score the results are excellent in 72 % and good in 28 %. All patients had been satisfied by the total result of surgery. Conclusion: In selected cases arthroplasty of the destructed elbow joint leads to excellent and good functional results with a high percentage of patients satisfaction.

Schlüsselwörter

Rheumatoide Arthritis - Gelenkersatz - Ellbogengelenk

Key words

Rheumatoid arthritis - elbow - joint replacement

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