Elbow Arthroplasty

The active elbow joint is very important for people's life and work, especially between 90° and 180°. Elbow joint activity is limited and there is severe pain, or those who are strong in non-functional status need to relieve pain and recovery function. The function of the elbow joint is to stabilize the activity with a certain degree. Elbow joint resection is difficult to maintain stability, elbow joint prosthesis replacement complications, fascia formation is still a feasible treatment, the efficacy can reach 78%. Treatment of diseases: elbow dislocation elbow joint tuberculosis traumatic elbow arthritis Indication 1. Due to traumatic fracture or dislocation of the elbow joint, most of the cartilage of the bone end is destroyed, the fracture ruptures and the deformed shape is healed, and the joint is strong and non-functional, which seriously affects the joint function. 2. The elbow joint is suffering from rheumatoid arthritis, which is strong enough to be non-functional. 3. Due to septic arthritis or tuberculosis with secondary infection, the elbow joint is stiff and non-functional, and the inflammation has been cured for more than half a year. Contraindications 1. The elbow is strong outside the joint. 2. When the elbow needs strength and stability more important than activity, it should be integrated into the functional position. 3. Elbow joint stiffness caused by osteomyelitis. 4. The biceps and forearms are weak. Preoperative preparation 1. The shoulder function of the affected limb should be normal. If the muscles of the joint are controlled, such as biceps and forearm muscles, if they are atrophied, they should first exercise and various physical therapy. After the muscles are restored or improved, the operation is performed. . 2. If there is a large scar on the elbow, you can do sputum resection and free skin grafting. After 4 to 6 weeks of skin grafting, arthroplasty is performed. 3. Patients with septic arthritis or secondary infection due to tuberculosis should be given antibiotics before surgery. 4. In addition to the skin preparation of the affected limb, the skin of one thigh should be prepared for the fascia. Surgical procedure 1. Position: Prone position, the affected limb is placed on the small surgery table or in the supine position, and the affected limb is placed on the chest. 2. Incision, separation of the ulnar nerve and exposure of the elbow joint: the subperiosteal revealed the lower 1/3 of the humerus, the ulna olecranon and the humeral head. 3. Cut the switch joint and trim the bone end: use the osteotome to gradually open the fused ruler, the iliac crest, and the proximal joint of the ulna along the joint space, and peel the anterior humerus under the periosteum. Then, flex the elbow joint so that the lower end of the humerus and the upper end of the ulna and ulna protrude beyond the incision. Use the osteotome to remove the lower end of the humerus 1~1.5cm, and renovate it into a convex arc shape from front to back; use a curved shape to remove the shallow bone of the ulnar half-moon notch to make it deeper and longer, and then remove the humeral head and neck. The plane of the lower edge of the ulnar notch, all the chiropractic surfaces of the ulna, such as the bone joint between the ulnar and ankle joints, should also be completely removed, and sutured with the surrounding soft tissue to make the forearm fully rotate. At this time, the distance between the ends of the elbow joint is about 1.5 to 2.0 cm. A fine drill bit is placed on the upper jaw of the lower end of the humerus, and a bone hole is drilled from the back to the front for suturing the fascia. All ossified tissues and scars in the soft tissue are removed, and all the broken bone pieces are removed. . After rinsing, completely stop bleeding, temporarily fill with hot saline gauze, press the mouth to prevent bleeding. 4. Cut the fascia: Make a long incision in the middle of the outside of the thigh of the sterilized drape, reveal the fascia, and remove the fascia of 8cm long and 5cm wide for spare. Suture the incision. 5. Wrap the bone end: the smooth side of the fascia is facing inward, the rough side is facing outward (to cover the end of the bone), and the middle part and the anterior joint capsule are sutured and fixed by three chrome guts or silk threads. The upper part of the fascia is used to wrap the lower end of the humerus, and the fascia is sutured and fixed through the lower end of the humerus. The lower part of the fascia is covered with the ulna and the humerus, and the fascia and ulna are separated by the fascia. The abutment of the facet. If the width of the fascia is not enough, another small fascia can be used, sutured with a purse, and the humeral head is wrapped separately. 6. Stitching: The joint was repositioned and maintained at a 90° flexion position, sutured from the distal end to the proximal end. If there is a triceps aponeurosis flap, a Y-shaped suture should be used to prolong the free movement of the elbow. After the end of the operation, the elbow joint was fixed to the functional position with the front and back gypsum support.

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