两种手术治疗老年骨质疏松性复杂肱骨远端骨折的早期疗效比较

Comparative of Two Surgical Methods for Treatment of Complex Osteoporotic Fractures of the Distal Humerus in Elderly

目的：探讨与分析切开复位双锁定接骨板内固定与人工全肘关节置换术两种不同手术方案治疗老年骨质疏松性复杂肱骨远端骨折的早期疗效。方法：2012年7月至2015年2月,回顾性分析30例老年骨质疏松性复杂肱骨远端骨折的患者：其中男10例,女20例;年龄60～72岁,平均65.7岁;骨折AO/ASIF分型为C2型9例,C3型21例;行切开复位锁定接骨板内固定和人工全肘关节置换术。其中双锁定接骨板内固定15例：男6例,女9例;年龄平均64.7岁;14例均为闭合性骨折,l例GustiloⅠ型开放骨折。人工全肘关节置换术15例：男4例,女11例;平均年龄65.8岁;15例均为闭合性骨折。术后配合镇痛及理疗康复锻炼。术后1,2,3,6,12,18个月进行随访调查,之后每6个月复查一次。采用MEPS评分系统进行评估。结果：术后随访时间12～22个月,平均18.5个月。双锁定接骨板内固定组平均屈伸范围84.5°±5.20°,人工全肘关节置换组平均屈伸范围101.5°±12.10°;两组比较差异有统计学意义（P=0.005）;双锁定接骨板内固定组MEPS评分平均（75.6±14.7）分,人工全肘关节置换组平均（86.3±11.7）分,两组比较差异有统计学意义（P=0.035）;双锁定接骨板内固定组MEPS优良率60%,人工全肘关节置换组MEPS优良率80%,两组比较差异无统计学意义（P=0.279）。双锁定接骨板内固定组术后并发症包括2例尺神经炎,10例异位骨化;人工全肘关节置换组术后并发症包括1例尺神经炎,l例肱三头肌肌力减弱,6例异位骨化。结论：对于老年骨质疏松性复杂肱骨远端骨折的治疗仍具有挑战性,Ⅰ期行人工全肘关节置换术较双锁定接骨板内固定近期能获较好的疗效,但术后远期的效果还有待进一步研究。

Objective：To detect and compare the efficacy of open reduction and double locking plate internal fixation（ORIF）and artificial total elbow arthroplasty（TEA）in the treatment of complex senile osteoporotic distal humerus fracture in elderly.Methods：Retrospectively 30 patients with complex osteoporotic fractures of the distal humerus in elderly,which were included in this study from July 2012 to February 2015.There were 10 males and 20 females,aged from 60 to72 years（65.7in averagely）.There were 9cases were type C2,and 21 cases were type C3 by AO/ASIF classification.In ORIF group,there were 6 males and 9females with an averaged 64.7years old,and 14 cases were closed fracture and one case was typeⅠGustilo open fracture.In TEA group,there were 4males and 11 females with an averaged 65.8 years old,all cases were closed fracture.Analgesia and rehabilitation were necessary for post-operative patient.They were follow-up at 1st,2nd,3th,6th,12 th,and 18 th months after operation.The Mayo elbow performance score（MEPS）and the complications were compared.Results：The average follow-up time was 18.5 months（from 18 to 22 months）.In ORIF group,the average total range of motion was 84.5°±5.20°,the MEPS was（75.6±14.7）points,and the excellent and good rate was 60%.The complications included heterotopic ossifications（10cases）and ulnar nerve dysfunction（2case）.In TEA group,the average total range of motion was 101.5°±12.10°,the MEPS was（86.3±11.7）points,and the excellent and good rate was 80%.The complications included heterotopic ossification（6case）,ulnar nerve dysfunction（1case）,and weakness of brachial triceps muscle（1case）.The patients in TEA group had significantly better range of motion（P=0.005）,and MEPS（P=0.035）than those in ORIF group.Conclusion：The treatment for complex senile osteoporotic distal humerus fractures in elderly is challenging.The curative effect of TEA is super than ORIF in the near future,but the postoperative long-term effect remains to be further research.