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1. 23-01-2003 and 07-01-2005 Clinic Follow-up
2. 06-01-2006 and 05-01-2007 Clinic Follow-up
3. 14-03-2008 and 18-07-2010 Clinic Follow-up
4. 07-01-2011 and 15-07-2012 Clinic Follow-up
5. 27-03-2013 Correspondence x线和CT扫描显示尺骨明显松动，长柄周围有碎片骨，仅残留2 - 3厘米的尺骨完整。肱干似乎固定得很好。  6. 04-04-2013 Operation Notes 7. 03-08-2013 Clinic Follow-up
8. 27-08-2013 Correspondence Diagnosis: Post single stage revision of right elbow replacement with ulnan component inserted into radius due to bone loss on ulnar side. 右肘关节置换术后尺骨假体置入桡骨因尺侧骨质丢失一期翻修术后。 Treatment Plan: Review in three weeks with an x-ray on arrival. 三周后复查时拍x光片。 I reviewed Mrs ltta in clinic today. I am glad to say that the pain in her right elbow is improving. She does notice some crepitus on flexion and extension of the elbow and this seems to be on the ulnar side. Her flexion and extension is excellent with extension to about 10°of fully straight and flexion to 140°. Her supination and pronation is limited but checking her handwriting today she is able to do well in her position of slight pronation. As she is progressing well and her pain improved, so preoperatively her SPONSA score was 0 and nowis 80%, we could see her in three weeks with an x-ray on arrival. 我今天在诊所给太太做了检查。我很高兴地说，她右肘的疼痛正在好转。她注意到在肘关节的屈伸活动中有一些捻音这似乎是在尺侧。患者屈伸功能良好，伸直约10°，屈曲140°。她的旋后和旋前受限，但检查她的笔迹，她可以在轻微旋前的位置上做得很好。由于她的病情进展良好，疼痛也有所改善，因此术前她的SPONSA评分为0分，现在为80%，我们可以在三周后通过x线检查来观察她。 Of note she is going to have physio today and is to remain in her brace as the plan postoperatively was for further three weeks. 值得注意的是，她将在今天接受理疗，并按计划在术后继续佩戴三周支具。 9. 18-08-2015 Clinic Follow-up
10. 19-04-2016 Clinic Follow-up
11. 22-04-2016 Correspondence 2. August 2013 single stage revision of the right total elbow replacement with ulnar component inserted into radius for presumed aseptic loosening under the care of Mr A. 2013年8月Mr A对右侧全肘关节置换术后尺骨假体插入桡骨进行一期翻修术 3. In 2010, revision right elbow replacement under the care of Mr B. 2010年B先生进行右肘关节翻修术 4. In 2009, revision right elbow replacement under the care of Mr B. 2009年BBB进行右肘关节翻修术 5. In 1997, right elbow replacement under the care of Mr B. 1997年B先生行右肘置换术。 Management Plan: 1. Use of Polysling for comfort. 使用polyling保持舒适性 2. Do not use right arm for weightbearing activities. 不要使用右臂进行负重活动 3. We will get back to the patient with further plan following discussion with Mr A. 在与A先生讨论后，我们将进一步的计划返回给患者。 It was a pleasure to meet this 69-year-old right-hand dominant lady with the background of rheumatoid arthritis. She was doing quite well with her elbow replacement until about 12 months ago. Over the last two months, she started having pain in her right forearm. She has also noticed some deformity of right forearm. Distally the wrists and hands are deviating towards the ulna. She is still managing to do daily activities however she tells me she has learnt over the years to mainly rely on the left arm. 很高兴见到这位69岁的右手边的女士，她有类风湿关节炎的背景。她的肘关节置换术后恢复得很好直到12个月前。在过去的两个月里，她的右前臂开始疼痛。她还注意到右前臂有些畸形。手腕和手的远端向尺骨偏移。她仍然在努力做日常活动，但她告诉我，多年来她已经学会主要依靠左臂。 On examination, she has got full flexion comparable to the contralateral side. She has got hyperextension of about 5°. She has got tenderness around mid radius. Her hands are neurovascularly intact and I note that it has been previously fused by Mr B at the wrist. Her radiographs today show periprosthetic fracture of the radius. 在检查中，她已获得与健侧相当的完全屈曲。她有过伸约5°。她桡骨中段有压痛。她的手有完整的神经血管我注意到之前是由B先生在手腕处融合的。她今天的x线片显示桡骨假体周围骨折。
Given that this has been going on for a couple of months, I have put her in a Polysling for comfort. She should avoid weightbearing on that side. I will discuss this case with Mr A and get back to her with a further plan. 12. 17-05-2016 Correspondence Mrs XXX very kindly attended my clinic today accompanied by her daughter and husband. 今天XXX女士在她的女儿和丈夫的陪同下来到了我的诊所。 Approximately two months ago Mrs XXX recognised that she had deformity with disability of her right forearm in which we undertook an unorthodox revision elbow replacement three years ago. Radiographs showed a fracture around the tip of the prosthesis with a sheer piece fragment. Tire is angulation with rotation so that the distal forearm is now held in neutral rotation rather than the pronation position that we adopted for functional improvement previously. 大约两个月前，XXX女士发现她的右前臂功能部分缺失，我们在三年前进行了非正统的翻修肘关节置换手术。x线片显示假体尖端周围骨折，并有一块薄片碎片。旋转成角，使远端前臂现在保持中立旋转，而不是我们以前为改善功能而采用的旋前位置。 We have discussed this in some detail today. The options are: 1. to leave the arm as it is and hope for natural healing, which I feel would be highly unlikely; 2. to straighten the arm and to try to perform external plating, which I think would be extremely difficult due to the fragility of the bone and the lack of bone stock into which one could fix screws; 3. replace the entire implant including the humerus and forearm components given that there are no forearm components that are any longer in dimension; 4. or shorten the forearm by 2 cm, and after retrieval of the distal cement plug re-cement the current forearm component into the distal radius, with impaction of the proximal and distal forearm cortices one into the other. Of the two latter options we prefer the last because this leaves the most options available for later if necessary. In addition the humeral component appears to be in reasonable condition and alignment and it will be desirable not to interfere with that. 我们今天已经详细讨论了这个问题。选择有: 1. 让手臂保持原样，希望自然愈合，我觉得这是极不可能的; 2. 伸直手臂，并尝试进行外固定，我认为这将是极其困难的，因为骨骼脆弱，缺乏可以固定螺丝的骨料; 3. 替换包括肱骨和前臂组件在内的整个植入物，因为没有前臂组件的尺寸; 4. 或将前臂缩短2 cm，然后取出远端骨水泥塞，重新将当前的前臂组件植入桡骨远端，并使近端和远端前臂皮质相互撞击。 在后两个选项中，我们更倾向于最后一个，因为如果需要，这将把大多数选项留给以后使用。此外，肱骨成分似乎处于合理的状态和排列，最好不要干扰。 Mrs XXX was very kind to remark that she had gained benefit from the previous revision, three years ago, and if we could get back to that status that would be satisfactory. I confirm therefore that Mrs XXX's name is now on our list for surgery, and I hope to be able to write to you about the condition of the arm shortly given that I have placed a priority on the admission. XXX女士非常友好地表示，她在三年前的上次修改中获益良多，如果我们能回到以前的状态，那将是令人满意的。因此，我确认夫人的名字现在在我们的手术名单上，鉴于我已经优先考虑让她入院，我希望很快就能写信告诉你她手臂的情况。 13. 01-07-2016 Clinic Follow-up
14. 11-07-2016 Clinic Follow-up
15. 13-07-2016 Clinic Follow-up
16. 14-07-2016 Correspondence Diagnoses: 1. Underwent revision of right radius implants for periprosthetic fracture of the right elbow replacement. 因右肘关节置换术后假体周围骨折行右桡骨内固定翻修术 2. Right forearm periprosthetic fracture 右前臂假体周围骨折 Current Issue: Loosening of radial component with prominent metalwork. 主要结构的的松动 Management Plan: For open reduction and internal fixation with a short plate and monocortical screws plus re-cementing of the stem. 切开复位短钢板、单皮质螺钉内固定，再进行骨水泥固定 Thank you for coming to see me in our Shoulder and Elbow Clinic today. You are currently two weeks following your operation. I am sorry to hear that three days ago you felt there was some displacement within your forearm. There was no history of trauma. You told me that you are just doing your exercises as suggested by physiotherapist. You subsequently attended A&E department at Royal Hospital where they put in a backslab. 谢谢你今天来我们的肩肘诊所看我。你现在已经手术两周了。我很遗憾地听说三天前你觉得你的前臂有些移位。无外伤史。你告诉我你只是按照理疗师的建议做运动。你后来去了皇家某医院的急诊科他们在那里装了背板。 On examination, your hand is neurovascularly intact. Your wound has healed, with no evidence of infection. There is no imminent danger to the overlying skin in your forearm. 经检查，你的手没有神经血管损伤。你的伤口已经愈合了，没有感染的迹象。前臂上的皮肤没有迫在眉睫的危险。 Radiographs today show loosening and displacement of the radial segment. As such, the radial aspect of the implant is protruding through the bone and is within the surrounding soft tissue. I have put you back in a backslab today just for comfort. Following discussions with Mr Lambert, I will arrange for you to come in for revision, fixation of your fracture. 现在的x线片显示桡骨节段有松动和移位。因此，径向的内植入物是突出通过骨和周围的软组织。我今天把你放回backslab，只是为了让你舒服。经过和A先生的讨论，我会安排你来翻修，固定你的骨折。 17. 16-08-2016 Operation Notes 在GA和神经阻滞下。切口在先前的右前臂背侧切口之上。如上所述。解剖到桡骨，保护相关的n/v结构和肌腱。用刮匙和骨刀从桡骨远端取出骨水泥。翻修骨水泥，桡骨远端桡骨组件复位和14g钢丝张力带捆扎。冲洗，分层加压。单克隆3-0至皮肤，无菌。
18. 05-10-2016 Correspondence
19. 27-11-2016 Clinic Follow-up
20. 07-12-2016 Correspondence Diagnosis: Rheumatoid arthritis. Surgical interventions: 1. Primary right elbow replacement 1997 2. Subsequent revisions in 2009 in 2010 3. Single stage revision of right total elbow replacement wit ulnar component inserted into radius for extensive bone loss 2013 under Mr Lambert 4. Tension band wiring for periprosthetic fracture of ulnar component stem August 2016. Current problem: Fracture of ulnar component stem 27 November 2016. 2016年11月27日尺骨假体柄骨折 I reviewed Mrs XXX in clinic today with her daughter. As a result of the multiple surgeries and extensive bone loss and the recent periprosthetic fracture of the ulna, the ulnar stem has fractured because of fatigue failure. Her distal wrist fusion being an important factor. 今天我带着XXX女士的女儿在诊所复查了一下。由于多次手术和广泛的骨丢失以及近期的尺骨假体周围骨折，尺骨柄因疲劳失效而断裂。腕关节远端融合是一个重要因素。 We had a long and frank discussion that any strategy for revision was complicated and associated with risks, and could fail early and result in a further periprosthetic fracture. 我们进行了长期而坦率的讨论，认为任何翻修策略都是复杂的，与风险相关，可能会早期失败并导致进一步的假体周围骨折。 We discussed that it was likely that this would require a non-standard custom implant, potentially requiring external fixation extending on to the wrist of the distal radius. 我们讨论过，这可能需要一个非标准的定制植入物，可能需要延伸到桡骨远端腕部的外固定。 In order that I could discuss the possibilities of what is appropriate mechanically, I have advised her that I will have initial conversations with the designers at Stanmore implants. 为了讨论合适的固定方式的可能性，我已经建议她，我将与斯坦莫尔植入物的设计师进行初步对话。 I have therefore arranged to see her again in two weeks time to discuss her options further. 因此，我已安排在两周后再次与她见面，进一步讨论她的选择。 21. 25-01-2017 Clinic Follow-up
22. 17-02-2017 Correspondence Many thanks for writing to me about our mutual patient, Mrs XXX. 非常感谢您来信介绍我们共同的病人XXX女士。 As you know, Mrs XXX was previously under the care of my former colleague, Mr A, who has undertaken all her previous surgery. As you know from assessing the x-rays, the ulnar component of the elbow replacement which has previously been positioned in the radius, has fractured at the level of the radial osteotomy site which has also gone onto non-union. When I met Mrs XXX in clinic, I had hoped that I had explained the full complexity of the problem, but perhaps from what you suggest in your letter, that was not the case. The elbow replacement which is currently in situ is a Coonrad/Morrey which is manufactured by Biomet Zimmer and due to the bone deficiency both in the ulna and radius, it is likely that we are going to need to undertake a proximal radial replacement with extrame dullary fixation to the wrist. The exact details are yet to be a finalised, as Mrs XXX is imminently due to have a fine-cut CT scan at the request of Biomet Zimmer for them to incorporate into a potential design. 如你所知，XXX女士之前由我的前同事A先生照顾，她之前的所有手术都是由A先生完成的。从x光片上可以看出，肘关节置换的尺骨假体之前是插入桡骨上的，在桡骨截骨处发生了骨折及发生了不愈合。当我在诊所见到XXX女士时，我希望我已经解释了这个问题的全部复杂性，但也许从您在信中提出的建议来看，情况并非如此。目前在原位的肘关节置换是由Biomet Zimmer公司生产的Coonrad/Morrey，由于尺骨和桡骨的骨缺损，我们可能需要进行桡骨近端置换，并将腕部的髓外固定。具体细节尚未敲定，因为应Biomet Zimmer的要求，XXX女士即将进行一次精细薄层CT扫描，以便将其纳入潜在的设计中。 23. 11-04-2017 Correspondence Underlying Diagnosis: Rheumatoid arthritis. 风湿性关节炎 Current Problem: Fracture of ulnar component stem placed in the radius 27 November 2016. 2016年11月27日桡骨髓腔内尺骨假体柄骨折。 I reviewed Mrs XXX in the clinic today to update her on the current situation. Reviewing her images we were able to discuss in detail the technical difficulties relating to her elbow replacement given the absence of ulnar bone. A fracture of the radius with a distal radiocarp al fusin. We discussed that off-the-shelf prosthesis was inadequate and therefore we were in the process of designing a custom implant with the company Zimmer, who manufacture the Coonrad/Morrey elbow replacement in situ. I was able to show her the initial design that had been presented to me, which through discussion with Zimmer would be finalised. I promised her that when the final design is agreed, I would send her and Mr B a so she would know what to expect. 我今天在诊所检查了XXX女士，向她更新了目前的情况。回顾她的影像，我们能够详细讨论在尺骨缺失的情况下，与肘关节置换术相关的技术困难。桡骨骨折伴远端桡骨骨融合。我们讨论了现有的假体是不够的，因此我们正在与生产Coonrad/ Morrey原位肘关节置换术的Zimmer公司一起设计定制假体。我向她展示了我拿到的最初设计，经过与Zimmer的讨论，最终会完成。我答应她，当最终的设计被同意后，我会给她和B先生寄一份，这样她就知道会发生什么。 As part of this discussion we had a frank conversation about the potential risks and complications including the potential risk of loosening which one could not look at the literature to assess risk based on this being a custom implant. As she is at present comfortable and managing to a certain extent with the forearm splint, one of her options for consideration was to not undertake surgery at all. 作为讨论的一部分，我们坦率地讨论了潜在的风险和并发症，包括潜在的松动风险，我们无法通过文献来评估风险，因为这是一个定制的植入物。由于她目前感到舒适，并在一定程度上使用前臂夹板，因此她考虑的选择之一是完全不进行手术。 Clinic Follow-up
25. 04-08-2017 Correspondence 26. 17-05-2018 Operation Notes Coonrad-Morrey全肘关节置换术后尺骨柄松动骨折伴右侧尺桡骨广泛骨质流失 Operation: Complex revision Ulna component (fixed inradius) of Coonrad-Morrey TER to Custom Proximal radial replacement linked to humeral component 定制桡骨近端假体翻修尺骨假体(桡骨内固定)Coonrad-Morrey TER后与肱骨假体 Findings Humerus well fxed. Well preserved tissue planes in dorsal compartment of forearm. Radius fractured, stem loose. Metallosis. Bone of carpus soft. Wrist fused. No evidence of infection until concerned raised when sing extensor mechanism through posterion incision. As needle passed through tissue concern raised about appearance of possible pus. Therefore further debridement pulse lavage and specimens sentto micro and triple Abx commenced until results available. 肱骨固定良好。前臂背侧间室组织平面保存良好。桡骨断裂，尺骨柄松动。Metallosis。腕骨柔软。手腕融合。经后伸肌切开术后未发现感染。当针穿过组织时，担心可能出现脓液。因此，进一步的清创脉冲灌洗和标本送往微量和三重Abx开始，直到有结果。 Procedure Posterior incision to elbow through previous scar. Ulna nerve dentified and protected. Extensor mechanism incised exposing articulation. Condylar pins removed and components dissociated. Dorsal approach to radius through previous incision. Interval between ECRB and EDC developed. Subperiosteal dissection of soft tissues from fragmented radial bone. Radial bone removed. Distal radius recut-osteotomy length determined from custom component. Small cement plug removed and radius rasped. Irrigation with pulse lavage. Third metacarpal and carpus exposed. 肘部后方切口穿过以前的瘢痕。确定并保护尺神经。伸肌装置切开暴露关节。销钉被移除，组件分离。通过先前的切口，桡骨背侧入路。取ECRB与EDC间隔。桡骨碎片的软组织骨膜下剥离。桡骨切除。桡骨远端截骨长度由定制组件确定。去除小的水泥塞并磨平骨端。脉冲灌洗冲洗。第三掌骨和腕骨外露。 Retrograde insertion of cement into distal radius. Custom radial component inserted with anterior flange and intramedullary stem. Posterior fiange attached with 2 bolts. Posterior flange fixed to carpus and 3rd metacarpal with locking screws. New bushings placed at ebow articulation between humeral and radial component. EUA=0-0-130. Hand in neutral rotation. Irrigation with pulse lavage. PIN and ulna nerve stimulated. Dorsal wound forearm and wrist closed in layers. Skin not unduly tensioned. 逆行植入骨水泥至桡骨远端。定制径向组件插入前凸缘和髓内柄。后翼与2个螺栓连接。后缘用锁定螺钉固定于腕和第三掌骨。在肱骨和桡骨组件之间的ebow关节处放置新的衬套。欧洲大学协会= 0-0-130。手旋转中立位。脉冲灌洗冲洗。Probe探查尺神经。前臂和腕部的背侧伤口分层闭合。皮肤松紧张力合适。  27. 05-06-2018 Correspondence Diagnoses: 1. Loose fractured ulnar stem of Coonrad-Morrey total elbow replacement right side. 右侧Coonrad-Morrey全肘关节置换术后尺侧骨折松动 2. Extensive bone loss of radius and ulnar. 桡骨和尺骨的广泛骨质丢失 Operation: Complex revision ulnar component fixed in radius of Coonrad-Morrey total elbow replacement to custom proximal radial replacement linked to humeral component under Miss C 17 May 2018 2018年5月17日Coonrad-Morrey全肘关节置换术复杂翻修尺桡骨组件固定至定制桡骨近端置换连接肱骨组件 Plan: Review in six weeks' time. We saw this pleasant lady in our clinic today. She is coming up to three weeks post-surgery. She feels well in herself and not complaining of any pain. With the dressings off today I assessed the wound, which looks healthy. The wound has healed very nicely. We have cut the stitch ends today as well. She demonstrated that she is doing the passive range of movement exercises and she is getting from 0 to 90° at the moment. 我们今天在诊所里见到了这位和蔼可亲的女士。她已经手术三周了。她感觉很好，没有抱怨任何疼痛。今天卸了敷料，我检查了伤口，看起来很健康。伤口愈合得很好。我们今天也把缝线剪断了。她展示了她正在做被动的范围运动练习她现在的角度是0到90度。 Moving on from here, we have advised her to continue wearing the plaster of Paris splints for another four weeks and to continue the passive elbow range of motion with gravity eliminated for another four weeks. We will see her in six weeks and repeat an X-ray of her right radius and ulna and elbow on arrival. 从这里开始，我们建议她继续佩戴Paris石膏夹板4周，并在消除重力的情况下继续肘关节被动活动4周。我们会在六周后给她做一次右桡骨，尺骨和肘部的x光检查。 28. 17-07-2018 Clinic Follow-up
29. 21-05-2019 Correspondence Diagnoses: 1. Right side Conrad/Murray total elbow replacements and revision to a custom proximal radial replacement into Visionaire components on 17th May 2018. 2018年5月17日，右侧Conrad/Murray全肘关节置换和定制桡骨近端置换至Visionaire组件的翻修。 2. Concerns over extensive bone loss at the radius and ulna previously. 前期对桡骨和尺骨广泛骨质丢失的担忧。 3. Concerns over previous loosening. 前期对松动的担忧 4. Radiographs today are satisfactory. Plan: 1. Review in 12 months' time with an x-ray upon arrival. 在12个月内复查，并在到达后进行x光检查。 2. The patient to contact if any changes to surgical condition or function of the right forearm. 若手术情况或右前臂功能有任何变化，患者应及时联系。 I was delighted to see Mrs XXX today in clinic who had the above procedure on 17th May 2018 to good effect. She has not noticed any concerning features such as clicking, clunking or loosening and has an excellent range of motion achieved today with extension to 0°, flexion to 135°. Understandably she has no pronation or supination. She has no loosening or toggle detected on the either the humeral or wrist components. Furthermore, she has no concerning features at the level of elbow hinge. Furthermore, she has normal sensation but I do note that her dorsiflexion of the forearm extensors are somewhat weaker. She has normal radial nerve sensation. She achieved very good functionality following this. 我很高兴今天在诊所见到夫人，她于2018年5月17日接受了上述手术，效果良好。她没有注意到任何令人担忧的特征，如咔哒声、撞击声或松动，并且具有良好的活动范围，目前已达到伸直至0°，屈曲至135°。可以理解她没有旋前或旋后。患者的肱骨或腕关节组件均未检测到松动或拨动。此外，她在肘关节铰链水平没有令人担忧的特征。此外，她的感觉正常，但我注意到她的前臂伸肌背伸有点弱。桡神经感觉正常。在此之后，她实现了非常好的功能。 She did not describe any pain in the upper limb. SPONSA of 40%. She has adapted to be left handed in her day-to-day activities. We will see her in 12 months time with an x-ray upon arrival or sooner should the need occur. 患者未描述上肢疼痛。SPONSA为40%。她已经习惯了用左手进行日常活动。我们将在12个月后给她做x光检查，如果有需要的话。
30. 19-05-2020 Correspondence Diagnosis: Revision total elbow to custom proximal radial replacement 2018. Right side. 2018年右全肘关节翻修至定制桡骨近端置换 This patient was contacted over the telephone due to the limitations on followup clinics during the Coronavirus pandemic. It was a pleasure to speak to this 73-year-old lady on behalf of Miss C today. She is now two years following her revision elbow replacement to a custom radial replacement. Overall, she is doing very well and she reports no pain on movement or at rest in her right elbow or forearm. She also reports that the wounds have well-healed with no evidencefor infection or redness. She informs me she is able to flex her elbow up and can fully straighten. 由于冠状病毒大流行期间随访诊所的限制，我们通过电话联系了该患者。很高兴今天能代表C小姐与这位73岁的女士交谈。她现在已经在肘关节置换翻修术后两年接受了定制桡骨置换。总体而言，患者恢复良好，右肘部或前臂在运动或休息时无疼痛。她还报告说，伤口愈合良好，没有感染或发红的迹象。她告诉我，她可以弯曲她的肘部向上，可以完全伸直。 She does note that she feels quite weak in the right elbow and so finds it difficult to lift a hot drink for example. She understands that given her revision elbow this would be at the limit of her advisable lifting. She also reports that she has not had any physiotherapy in the two years since her post-op period. I would therefore be grateful if you could arrange for this to be done locally for her, obviously once the restrictions due to the pandemic have been lifted. 她注意到她感觉右肘很虚弱，所以举一杯热饮之类的东西很困难。她知道，由于她的肘关节在翻修，这将是她的适当的举起的极限。患者还报告自术后两年内未接受任何物理治疗。因此，如果你能安排在当地为她做这件事，我将非常感激，当然是在疫情限制解除后。 With regards to her elbow custom forearm replacement, we will follow her up in our Virtual Clinic in 12 months intervals and she is aware that she can contact the unit if she has any issues in the interim. 对于她的肘关节定制前臂置换术，我们将每隔12个月在我们的虚拟诊所对她进行随访，她知道如果在这期间有任何问题，她可以联系我们的单位。 31. 12-05-2021 Clinic Follow-up
32. 05-08-2021 Correspondence Treatment: Complex revision right ulnar component with custom total radial replacement linked to Coonrad-Morrey humeral component. Date of surgery 17 May 2018. 复杂翻修右尺骨组件与定制的全桡骨置换连接到Coonrad-Morrey肱骨组件。手术日期2018年5月17日。 Plan: OT, Physio review. I met with Mrs XXX today in the clinic with her daughter after she was recently reviewed in our Virtual Clinic. During that appointment, she had mentioned that she has started to notice some weakness in the right arm which was affecting function. She reiterated today that there was no pain. 我今天在诊所见到了夫人和她的女儿，她最近在我们的虚拟诊所接受了检查。在那次就诊期间，她提到她开始注意到右臂有一些无力，影响了功能。她今天重申没有疼痛。 Examining her today, she had excellent range of movement but it was clear that she had weakness in triceps when gravity was in play, causing some functional difficulties. We discussed that I felt that the best way forward would be a review by one of my OT and Physio colleagues in a combined appointment to see if they could improve the situation. I did not feel that there was a surgical strategy that I would feel appropriate. 今天检查时，她的活动范围很好，但很明显，在重力作用下，她的肱三头肌无力，导致了一些功能障碍。我们讨论说，我觉得最好的办法是让我的一个OT和Physio同事一起检查，看看他们是否能改善情况。我觉得没有合适的手术策略。 Mrs XXX was very happy with this strategy and, therefore, I have made the necessary arrangements. 太太对这个策略很满意，因此，我做了必要的安排。 She mentioned in clinic that she had started to develop symptoms in the left elbow but demonstrated preserved range of movement with no crepitus and no obvious discomfort on examination. We discussed that whilst I do not have any imaging of the left elbow, I suspect that she probably had evolving arthritis and, therefore, we agreed that we would review both elbows in 12 months' time, obtaining x-rays of both at the appointment but she is aware that should her symptoms deteriorate, then she could contact my secretary to bring that forward. 她在门诊中提到，她开始出现左肘关节的症状，但在检查中显示活动范围保留，无捻音，无明显不适。我们讨论过，虽然我没有任何左肘关节的影像学检查，但我怀疑她很可能患有不断发展的关节炎，因此，我们同意在12个月的时间内复查双肘关节，在预约时拍摄双肘关节的x光片，但她知道如果她的症状恶化，她可以联系我的秘书提前检查。 33. 24-09-2021 Correspondence Presenting complaint Complex revision right ulnar component with custom total radial replacement linked to Conrad Murray humeral component 17 May 2018, request for joint Physio and OT review with regards to decreased function and weakness in the right upper limb. 2018年5月17日，由于右上肢功能下降和无力，要求关节理疗师和骨科检查。 Thank you for asking us to review to see if there was anything we could contribute to help improve function and weakness in the right upper limb. Unfortunately, on clinical assessment it appears that the triceps now is completely dysfunctional. There is considerable muscle wastage. She cannot function even with gravity eliminated and it was difficult to palpate any significant muscular contraction. Therefore I think it would be extremely difficult to for any exercises to make any significant functional gains. She was also seen by April in OT, and we discussed hinge braces, but in discussion the patient has already found clever ways of modifying to remain functional. She has stopped driving, but we have asked her to consider making contact with local Motability services to see if certain adaptations may allow her to start driving again. 谢谢你让我们检查看看是否有什么可以帮助改善右上肢的功能和无力。不幸的是，临床评估显示肱三头肌现在完全功能障碍。有相当大的肌肉萎缩。即使消除了重力，她也不能正常工作，而且很难触诊到任何明显的肌肉收缩。因此，我认为任何锻炼都很难取得任何显著的功能增益。她在4月份的时候也去了OT，我们讨论了铰链支架，但在讨论中，患者已经找到了保持功能的巧妙方法。她已经停止开车，但我们已经要求她考虑与当地的汽车公司联系，看看是否有一些调整可以让她重新开始开车。 34. 09-08-2022 Clinic Follow-up
致谢: 浙大二院骨科：叶招明主任 英国皇家国立骨科医院：Miss Deborah Higgs |
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