Academic Department of Trauma, & Orthopaedics, School of Medicine, University, of Leeds, Leeds, UK.
Injury. 2009 Jun;40(6):582-90. doi: 10.1016/j.injury.2009.01.123. Epub 2009 Apr 24.
Treatment of complex distal humeral fractures in older patients with osteopenic bone remains a major surgical challenge. We report the results of 11 patients over 75 years of age who underwent semiconstrained sloppy-hinge total elbow arthroplasty (TEA) due to comminuted intraarticular fractures of the distal humerus. There were 9 women and 2 men with a mean age of 79.6 years. The mean duration of follow up was 2.8 years. According to AO classification, there were 8 type C3 and 3 type C2 fractures. The mean time from injury to operation was 4.3 days and the mean length of hospital stay was 9.8 days. The elbow flexion/extension and forearm pronation/supination arc of motion averaged 107(0) and 121(0) respectively. The mean Mayo Elbow Performance Score (MEPS) was 90 points, equivalent to excellent result. One patient sustained a periprosthetic humeral fracture and signs of non-progressive radiolucency were found in 8 out of the 11 elbows. Our search in the English and International literature revealed 9 other clinical studies describing the results of TEA in 167 patients with 168 distal humeral fractures. The mean age of patients varied from 69 to 84.6 years and the mean follow up from 17.8 months to 7 years. The mean MEPS among the studies was between 85 and 95 points. Wound infection was diagnosed in 9 cases (5.4%) but component removal and subsequent reimplantation was only applied in 3 elbows (1.8%). Partial ulnar nerve lesions were reported in 11 patients (6.5%) and reflex sympathetic dystrophy was developed in 5 patients (3%). In 3 elbows (1.8%) a periprosthetic fracture after a fall was recorded. Radiolucent lines between the cement mantle and bone interface were described in 24 cases (14.3%) but the majority of them (17 cases) were stable and asymptomatic. In conclusion, TEA constitutes a viable treatment option for the complex distal humeral fractures in elderly and medically compromised patients. Careful patient selection and regular follow up evaluation are mandatory for achieving an optimal result and eliminating the risks of mismanagement and early implant failure.
治疗骨质疏松症老年患者的复杂肱骨远端骨折仍然是一项重大的手术挑战。我们报告了 11 名 75 岁以上患者的结果，这些患者因肱骨远端粉碎性关节内骨折行半约束性松质铰链全肘置换术 (TEA)。其中 9 名女性和 2 名男性，平均年龄 79.6 岁。平均随访时间为 2.8 年。根据 AO 分类，有 8 例 C3 型和 3 例 C2 型骨折。从受伤到手术的平均时间为 4.3 天，平均住院时间为 9.8 天。肘部屈伸和前臂旋前/旋后活动弧平均为 107(0)和 121(0)。平均 Mayo 肘功能评分 (MEPS)为 90 分，相当于优秀结果。1 例患者发生假体周围肱骨骨折，11 例中有 8 例出现进展性透亮线。我们在英文和国际文献中检索到 9 项其他临床研究，描述了 167 例 168 例肱骨远端骨折患者 TEA 的结果。患者的平均年龄从 69 岁到 84.6 岁不等，平均随访时间从 17.8 个月到 7 年不等。研究中 MEPS 的平均得分在 85 到 95 分之间。诊断出 9 例（5.4%）伤口感染，但仅在 3 例（1.8%）中进行了假体去除和随后的再植入。11 例（6.5%）患者出现部分尺神经病变，5 例（3%）患者出现反射性交感神经营养不良。在 3 例（1.8%）患者中，因跌倒导致假体周围骨折。在 24 例（14.3%）中描述了水泥覆盖层和骨界面之间的透光线，但大多数（17 例）是稳定且无症状的。总之，TEA 是治疗老年和合并症患者复杂肱骨远端骨折的可行治疗选择。仔细的患者选择和定期随访评估对于获得最佳结果和消除管理不当和早期植入物失败的风险至关重要。
J Bone Joint Surg Am. 1997-6
Oper Orthop Traumatol. 2005-6
Orthop Traumatol Surg Res. 2012-12-27
Rev Chir Orthop Reparatrice Appar Mot. 2008-6
Orthop Traumatol Surg Res. 2013-10-3
J Bone Joint Surg Am. 2004-5
Rev Chir Orthop Reparatrice Appar Mot. 2002-6
Eur J Trauma Emerg Surg. 2022-10
BMC Musculoskelet Disord. 2021-10-13
Zotero 插件