改良全肘关节置换治疗复杂肘关节骨折

Modified total elbow arthroplasty for treatment of complex elbow fractures

目的探讨改良全肘关节置换术治疗复杂肘关节骨折的方法和疗效。方法自2004年1月至2014年1月共收治7例复杂肘关节骨折患者，应用改良全肘关节置换进行治疗，根据前臂屈伸活动度、前臂旋转角度和Mayo肘关节评分标准评定疗效。结果术后7例患者平均随访34．6（12～73）个月，1例出现尺神经损伤，1例发生异位骨化，未出现感染及松动等并发症。术后前臂屈伸活动度从术前的（35．71±21．88）°上升到（107．86±11．85）°；前臂旋转角度从术前的（55．71±32．20）°上升到（72．14±31．07）°；Mayo肘关节评分从术前（25．71±13．36）分上升到术后（84．29±12．05）分。手术前后的前臂屈伸活动度、前臂旋转角度及Mayo肘关节评分比较，差异有统计学意义（P〈0．05）。结论在选择合适假体的前提下，改良全肘关节置换能减少软组织和骨质的损伤，加快术后康复及减少术后并发症的发生，是治疗复杂肘关节骨折的一种有效方法。

Objective To investigate the method and outcomes of the modified total elbow arthroplasty in the treatment of complex fractures of the elbow. Methods From January 2004 to January 2014, 7 cases of complex elbow fractures were treated with the modified total elbow joint replacement. The results were evaluated by range of motion of elbow flexion/extension, forearm rotation, and by Mayo elbow performance scores. Results All the patients were follow-up for a mean period of 34.6 months （range, 12 to 73 months）. Other than ulnar nerve injury in 1 case and heterotopic ossification in 1 case, there were no complications such as infection or loosening of the prostheses. Range of elbow flexion/extension motion increased from （35.71 ± 21.88）° preoperatively to （107.86 ± 11.85）° postoperatively. Forearm rotation range of motion increased from （55.71 ± 32.20）° preoperatively to （72.14 ± 31.07）° postoperatively. The Mayo elbow performance scores increased from 25.71 ± 13.36 to 84.29 ± 12.05 after the operation. All these changes were statistically significant （ P 〈 0.05）. Conclusion When a suitable prosthesis is chosen, modified total elbow arthroplasty can reduce damage to the bone and soft tissues, speed up postoperative rehabilitation and avoid postoperative complications. It is an effective method for the treatment of complex elbow fractures.