McKee M D, Wilson T L, Winston L, Schemitsch E H, Richards R R
Upper Extremity Reconstructive Service, St. Michael's Hospital, University of Toronto, Ontario, Canada.
J Bone Joint Surg Am. 2000 Dec;82(12):1701-7. doi: 10.2106/00004623-200012000-00003.
While surgical repair is considered the standard of care of displaced intra-articular distal humeral fractures, most investigators have assessed its results with use of surgeon-based and/or radiograph-based outcome measures. The purpose of our study was to determine the functional outcome of fixation of displaced intra-articular distal humeral fractures with use of a standardized evaluation methodology consisting of objective testing of muscle strength and use of patient-based questionnaires (both limb-specific and general health-status questionnaires).
We identified twenty-five patients (fourteen male and eleven female), with a mean age of forty-seven years, who had an isolated, closed, displaced, intercondylar, intra-articular fracture of the distal part of the humerus repaired operatively through a posterior approach and fixed with plates on both the medial and the lateral column. All patients returned for follow-up that included recording of a complete history, physical examination, radiographic examination, completion of both a limb-specific questionnaire (Disabilities of the Arm, Shoulder and Hand [DASH]) and a general health-status questionnaire (Short Form-36 [SF-36]), and objective muscle-strength testing.
The mean duration of follow-up was thirty-seven months (range, eighteen to seventy-five months). The mean flexion contracture was 25 degrees (range, 5 to 65 degrees), and the mean arc of flexion-extension was 108 degrees (range, 55 to 140 degrees). Significant decreases in mean muscle strength compared with that on the normal side were seen in both elbow flexion measured at 90 degrees (74 percent of normal, p = 0.01) and elbow extension measured at 45 degrees (76 percent of normal, p = 0.01), 90 degrees (74 percent of normal, p = 0.01), and 120 degrees (75 percent of normal, p = 0.01). The mean DASH score was 20 points, indicating mild residual impairment. The SF-36 scores revealed minor but significant decreases in the role-physical and physical function scores (p = 0.01 and 0.03, respectively) but no alteration of the mental component or mean scores. Six patients (24 percent) had a reoperation; three of them had removal of prominent hardware used to fix the site of an olecranon osteotomy.
The surgical repair of an intra-articular distal humeral fracture is an effective procedure that reliably maintains general health status as measured by patient-based questionnaires. Our study quantified a decrease in the range of motion and muscle strength of these patients, which may help to explain the mild residual physical impairment detected by the limb-specific outcome measures and physical function components of the general health-status measures.
虽然手术修复被认为是移位性肱骨远端关节内骨折的标准治疗方法，但大多数研究者使用基于外科医生和/或基于X线片的结果测量方法来评估其疗效。我们研究的目的是采用一种标准化评估方法来确定移位性肱骨远端关节内骨折固定后的功能结果，该方法包括客观的肌肉力量测试和使用基于患者的问卷（包括肢体特异性问卷和一般健康状况问卷）。
我们纳入了25例患者（14例男性和11例女性），平均年龄47岁，这些患者均为孤立的、闭合的、移位的、髁间的、肱骨远端关节内骨折，通过后路手术修复并用钢板固定在内侧和外侧柱上。所有患者均接受随访，包括记录完整病史、体格检查、影像学检查、完成肢体特异性问卷（手臂、肩部和手部功能障碍[DASH]）和一般健康状况问卷（简短健康调查简表[SF-36]）以及客观的肌肉力量测试。
平均随访时间为37个月（范围为18至75个月）。平均屈曲挛缩为25度（范围为5至65度），平均屈伸弧度为108度（范围为55至140度）。与正常侧相比，在90度时测量的肘屈曲（为正常的74%，p = 0.01）、45度时测量的肘伸展（为正常的76%，p = 0.01）、90度时测量的肘伸展（为正常的74%，p = 0.01）以及120度时测量的肘伸展（为正常的75%，p = 0.01）的平均肌肉力量均有显著下降。平均DASH评分为20分，表明存在轻度残余功能障碍。SF-36评分显示角色-身体和身体功能评分有轻微但显著的下降（分别为p = 0.01和0.03），但心理成分或平均评分无变化。6例患者（24%）进行了再次手术；其中3例取出了用于固定鹰嘴截骨部位的突出内固定物。
肱骨远端关节内骨折的手术修复是一种有效的手术方法，通过基于患者的问卷测量可可靠地维持一般健康状况。我们的研究量化了这些患者的活动范围和肌肉力量的下降，这可能有助于解释通过肢体特异性结果测量和一般健康状况测量中的身体功能成分所检测到的轻度残余身体功能障碍。
