Yin Qingwei, Jiang Yi, Fu Liaxin, Li Xiaodong, Tian Yonggang, Han Liqiang, Xiao Lianping, Zheng Jinxin
Department of Orthopaedics, Third Center Hospital, Tianjin, 300170, PR China.
Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi. 2009 Nov;23(11):1290-3.
To analyse short-term clinical effect of total elbow arthroplasty in treatment of distal comminuted humeral fracture with serious osteoporosis in geratic patients.
From April 2006 to October 2007, five cases of distal comminuted humeral fractures were treated by total elbow arthroplasty with bone cement. Of them, there were 2 males and 3 females, aging 50-76 years old (mean 67.6 years old), including 4 cases of closed fracture and 1 case of open fracture (II type Gustilo-Anderson). All fractures were caused by tumbling. According to classification of AO, there were 2 cases of type C1, 2 cases of type C2 and 1 case of type C3. The Barnett index of osteoporosis was 0.40-0.45. The time from injury to operation was 4 to 18 days (mean 7.2 days). The rehabilitation exercise of function was done after 2 days of operation.
The operative time was from 120 to 180 minutes (mean 150 minutes), the bleeding amount was from 150 to 250 mL (mean 200 mL). All incision achieved primary healing. No complication occurred. Five cases were followed up for 19 to 36 months (mean 24.5 months). The mean motion range of elbow joint include 141.6 degrees for flection, 6.5 degrees for extention, 10.2 degrees for the degree of ectropion, 81.7 degrees for revolve forward, and 73.8 degrees for revolve behind respectively after 4 months of operation. The length discrepancy of upper limb was less than 1.5 cm, the muscle force for flexion and extention of finger and wrist was normal. The X-ray films showed that the position of artificial joint was satisfactory without prosthesis dislocation or loosening. According to Mayo elbow performance score, the excellent and good rate was 80% (excellent in 1 case, good in 3 cases, and fair in 1 case).
Total elbow arthroplasty with bone cement is an effective method in treatment of distal comminuted humeral fracture with serious osteoporosis obviously in the geratic patients, but indication and technique of operation should be mastered strictly.
分析全肘关节置换术治疗老年严重骨质疏松性肱骨远端粉碎性骨折的短期临床疗效。
2006年4月至2007年10月，采用骨水泥型全肘关节置换术治疗5例肱骨远端粉碎性骨折患者。其中男2例，女3例，年龄50 - 76岁（平均67.6岁），闭合性骨折4例，开放性骨折（Gustilo-AndersonⅡ型）1例。所有骨折均因跌倒所致。按AO分类，C1型2例，C2型2例，C3型1例。骨质疏松的Barnett指数为0.40 - 0.45。受伤至手术时间为4 - 18天（平均7.2天）。术后2天开始进行功能康复锻炼。
手术时间120 - 180分钟（平均150分钟），出血量150 - 250ml（平均200ml）。所有切口均一期愈合，无并发症发生。5例患者随访19 - 36个月（平均24.5个月）。术后4个月时，肘关节平均活动范围分别为：屈曲141.6°，伸直6.5°，外翻10.2°，前旋81.7°，后旋73.8°。上肢长度差异小于1.5cm，手指及腕关节屈伸肌力正常。X线片显示人工关节位置满意，无假体脱位或松动。按Mayo肘关节功能评分，优良率为80%（优1例，良3例，可1例）。
骨水泥型全肘关节置换术是治疗老年严重骨质疏松性肱骨远端粉碎性骨折的有效方法，但应严格掌握手术适应证及技术。
