陈旧性肱骨远端复杂性骨折的人工肘关节置换

Clinical results of total elbow arthroplasty in the treatment of old complex distal humeral fractures

[目的]研究人工肘关节置换治疗陈旧性复杂性肱骨远端骨折的疗效。[方法]1998年1月～2008年12月对14例陈旧性肱骨远端复杂性骨折置换人工肘关节14例进行随访,患者平均59.2岁,平均随访时间为8.4年。原骨折按AO分型,C2型4例,C3型10例。假体关节为Coonrad-Morrey半限制性假体。对术前后疼痛、关节活动度、稳定性、肌力和并发症等作为重点,经由Mayo肘关节评价、DASH评价、影像学评价有无假体松动和异位骨化等。[结果]4例在强度屈肘时轻度疼痛,本组肘关节平均屈曲112.6°(0°～144°),平均伸肘7.9°,屈124°,术后平均伸直受限22°。术后平均旋前79.8°,旋后78.2°。14例肘关节稳定,患者对治疗结果满意。并发术中内侧柱骨折、尺神经麻痹和异位骨化各1例。无假体松动。Mayo肘关节评价优(>90分)7例,良(75～89分)7例。DASH评价平均48.2分(24.4～78分)。[结论]人工肘关节置换治疗陈旧性肱骨远端复杂骨折畸形愈合或创伤性关节炎患者,是一种疗效肯定的治疗手段。

[ Objective] To study the results of total elbow arthroplasty in the treatment of old-complex distal humeral fractures. [ Method] Since Jan. 1998 to Dec. 2008,14 cases were retrospectively studied. Patients were diagnosed old-complex fractures of the distal humerus and treated by total elbow arthroplasty with Coonrad-Morrey prosthesis. The mean age were 59.2 years old, the mean follow-up time were 8.4 years. According to AO classification, there were four cases in C2, and ten in C3. The study included ： pain evaluation, range of motion, elbow stability, muscle strength, complications, Mayo elbow score, DASH score, radiological assessment of ectopic bone formation and prosthesis loosening. [ Result] Four cases were with mildpain in el- bow strength flexing. The mean flexion were 112.6° （ range 0° - 144° ）, mean extension 7.9°, and flexion 124°, mean extension limit 22°, mean pronation 79.8 °, and supination 78.2°. All joint were stable postoperatively. All patients were satisfied with the outcome. There was fracture of humerus medi-lateraln colum in one case during operation, ulnar nerve symptoms in one, and ectopic bone formation in one. No looseing was found. Mayo elbow score were 7 patients of being excellent （ 〉 90） and 7 patients of being good （75 - 89 ）. The mean DASH score were 48.2 （ range 24.4 - 78 ）. [ Conclusion ] Total elbow arthroplasty can be used in such conditions as old-complex fractures of distal humerus, traumatic elbow arthritis and deformity union of fractures. The results are satisfying.