LaPorte Dawn M, Murphy Michael S, Moore J Russell
Department of Orthopaedic Surgery, The Johns Hopkins University, Baltimore, MD 21224-2780, USA.
Am J Orthop (Belle Mead NJ). 2008 Oct;37(10):531-4.
In nonunion after distal humerus fracture, osteoporosis, devascularized fracture fragments, and periarticular fibrosis limit potential reconstructive options. We assessed pain relief, functional gains, and complications in 12 patients whose long-standing, painful nonunions after previous treatment with rigid internal fixation were reconstructed with a semiconstrained total elbow arthroplasty, frequently with a triceps-sparing approach and anterior ulnar nerve transposition. At mean follow-up of 63 months, 11 patients had good pain relief and a good or excellent functional result: mean flexion/extension, 134 degrees to 18 degrees; mean total arc of motion, 117 degrees ; mean pronation/supination, 74 degrees to 69 degrees. Despite the 75% rate of complications (8), semiconstrained total elbow arthroplasty provides a viable treatment for this difficult problem.
在肱骨远端骨折不愈合的情况下，骨质疏松、骨折块血运丧失以及关节周围纤维化限制了潜在的重建选择。我们评估了12例患者的疼痛缓解情况、功能改善以及并发症，这些患者此前接受刚性内固定治疗后长期存在疼痛性骨折不愈合，采用半限制性全肘关节置换术进行重建，通常采用保留肱三头肌的入路和尺神经前置。平均随访63个月时，11例患者疼痛得到良好缓解，功能结果为良好或优秀：平均屈伸角度为134度至18度；平均总活动弧度为117度；平均旋前/旋后角度为74度至69度。尽管并发症发生率为75%，但半限制性全肘关节置换术为这个难题提供了一种可行的治疗方法。
