全肘关节置换治疗老年患者肱骨远端骨折骨不连12例报告

Total elbow arthroplasty for distal humeral nonunion in elderly patients:12 cases report

目的探讨全肘关节置换治疗老年患者肱骨远端骨折骨不连的临床效果。方法2005年2月至2010年11月，12例肱骨远端骨折骨不连患者行全肘关节置换手术。男5例，女7例，年龄（76±4）（69～83）岁。骨折类型（按照AO分型）：B型3例，C型9例。非手术治疗后肱骨远端骨折骨不连6例，切开复位内固定治疗失败6例。均采用美国Zimmer公司半限制型Coonrad—Morry人工肘关节假体进行关节置换。术后6个月进行MEPS评分（MayoElbow Performance Score）、肘关节活动范围检查和VAS评分等检查随访。结果12例均获（33．4±6．3）（25～45）个月随访。没有发生尺神经和血管损伤、肘关节脱位或关节不稳定、肱三头肌肌力弱、假体周围骨折、假体松动和断裂。MEPS评分由术前（29±13）（10-50）分上升到（85±10）（65～100）分（P〈0．05），其中优4例（33％），良6例（50％），可2例（17％）。肘关节活动范围从术前（18±11）（0～40）。提高到（108±21）（75～135）。（P〈0．05）；9例（75％）患者肘关节伸屈范围超过90°。患者肘关节疼痛明显缓解，VAS评分由（7．3±1．1）（5—9）分下降至（1．3±0．9）（0。2）分（P〈0．05）。结论全肘关节置换治疗老年患者肱骨远端骨折骨不连可以获得满意的临床效果。

Objective To investigate the clinical outcomes of total elbow arthroplasty （ TEA ） for distal humeral nonunion in elderly patients. Methods From February 2005 to November 2010, 12 patients with distal humeral nonunion underwent TEA. There were 5 males and 7 females, whose average age was （ 76±4 ） years old （ range; 69-83 years ）. The fractures were formerly classified according to the AO classification, including 3 cases of type B and 9 cases of type C. Distal humeral nonunion caused by the failure of non-surgical treatment occurred in 6 cases, and by the failure of open reduction and intemal fixation in the other 6 cases. The semi-constrained Coonrad- Morry artificial elbow joints （ Zimmer, Warsaw, IN, USA ） were used. The Mayo Elbow Performance Score （ MEPS ）, Range of Motion （ ROM ） of the elbow joint and Visual Analogue Scale （ VAS ） were investigated at 6 months after the operation. Results All patients were followed up for an average period of （ 33.4±6.3 ） months （ range; 25-45months ）. No ulnar nerve or vascular injuries, dislocation or instability of the elbow joint, weakness of the triceps muscle, perprosthetic fractures or prosthesis loosening or breakage were found. The average MEPS was （ 29±13 ） points （ range; 10-50 points ） preoperatively and （ 85±10 ） points （ range; 65-100 points ） postoperatively （ P〈0.05 ）. The results were excellent in 4 cases （ 33% ）, good in 6 cases （ 50% ） and fair in 2 cases （ 17% ）. The average ROM of the elbow joint was （ 18±11 ） degrees （ range; 0-40 degrees ） preoperatively, which was increased to （ 108±21 ） degrees （ range; 75-135 degrees ） postoperatively （ P〈0.05 ）. The flexion and extension of ROM of the elbow joint was more than 90 degrees in 9 patients （ 75% ）. The pain of the elbow joint in patients was obviously relieved. The VAS score was （ 7.3±1.1 ） points （ range; 5-9 points ） preoperatively, which was reduced to （ 1.3±0.9 ） points （ range; 0-2 points ） postoperatively （ P〈0.05 ）. Conclusions The clinical outcomes of TEA for distal humeral nonunion in elderly patients are satisfactory.