Schmidt-Horlohé K, Bonk A, Wilde P, Becker L, Hoffmann R
Abteilung für Unfallchirurgie und Orthopädische Chirurgie, Berufsgenossenschaftliche Unfallklinik Frankfurt am Main.
Z Orthop Unfall. 2010 May;148(3):300-8. doi: 10.1055/s-0029-1240736.
The aim of this study was to evaluate the functional results and determine/record the complications after treating distal humerus fractures with an anatomically precontoured and angular-stable double plate system (LCP Distal Humerus Plates, Synthes GmbH, Umkirch).
51 patients (30 female, 21 male) with 52 fractures of the distal humerus and a mean age of 51 years (14-94) were prospectively recorded over a period of 42 months and treated by open reduction and internal fixation using the above-mentioned LCP Distal Humerus Plates System. Follow-up was performed in 44 patients with 45 fractures after a mean of 13 months (6-24). According to the classification system introduced by the "Arbeitsgemeinschaft für Osteosynthesefragen" (AO [Association for the study of internal fixation, ASIF]) there were six A fractures (13.3%), five B fractures (11.1%) and 34 C fractures (75.5%). The AO/ASIF rate of type C3 fractures was 53%. Seven fractures were grade I (15.6 %) and three fractures grade II (6.7%) open. In addition to clinical examination and measuring range of motion (ROM), functional results were evaluated using the Mayo elbow performance score (MEPS) and the disabilities of the arm, shoulder and hand score (DASH).
Using the MEPS, excellent results were achieved in 19 patients (43.2%), good in 23 (52.3%), fair and poor each in one. Mean MEPS was 87.5 +/- 11.8 points (50-100). The mean DASH score reached 14.2 +/- 19.9 (0-65.8). Having a mean extension deficit of 10 +/- 14.1 degrees (0-40 degrees) and flexion up to 127.5 +/- 17.2 degrees (80-145 degrees), the mean ROM was 110 +/- 23.8 degrees (50-145 degrees). A primary stable osteosynthesis which allows early physiotherapy was gained in 38 fractures, in seven cases additional immobilisation was carried out (10 to 28 days). Postoperative complications were seen in eleven patients (24.4%). Overall revision surgery was necessary in nine cases.
By using the anatomically precontoured and angular-stable LCP distal humerus plates system a stable osteosynthesis allowing early physiotherapy is achieved in the majority of patients. Due to early initiation of physical therapy the functional results might be improved. Despite using the LCP system complications at the distal humerus fracture side were seen frequently, emphasising the challenging surgical procedure and demonstrating the need for further implant and surgical procedure improvement.
本研究旨在评估使用解剖预塑形且角度稳定的双钢板系统（锁定加压接骨板远端肱骨钢板，辛迪思股份公司，乌姆基尔希）治疗肱骨远端骨折后的功能结果，并确定/记录并发症情况。
前瞻性记录了51例患者（30例女性，21例男性）的52例肱骨远端骨折，平均年龄51岁（14 - 94岁），观察期为42个月，采用上述锁定加压接骨板远端肱骨钢板系统进行切开复位内固定治疗。44例患者的45处骨折在平均13个月（6 - 24个月）后进行了随访。根据“骨内固定研究学会（AO [内固定研究协会，ASIF]）”引入的分类系统，有6例A型骨折（13.3%），5例B型骨折（11.1%）和34例C型骨折（75.5%）。C3型骨折的AO/ASIF发生率为53%。7处骨折为I级开放性骨折（15.6%），3处为II级开放性骨折（6.7%）。除临床检查和测量活动范围（ROM）外，使用梅奥肘关节功能评分（MEPS）和上肢、肩部和手部功能障碍评分（DASH）评估功能结果。
使用MEPS评估，19例患者（43.2%）结果为优，23例（52.3%）为良，各有1例为中及差。MEPS平均为87.5 ± 11.8分（50 - 100分）。DASH评分平均为14.2 ± 19.9（0 - 65.8）。平均伸展受限10 ± 14.1度（0 - 40度），屈曲可达127.5 ± 17.2度（80 - 145度），平均ROM为110 ± 23.8度（50 - 145度）。38处骨折实现了允许早期物理治疗的一期稳定骨固定，7例患者进行了额外固定（10至28天）。11例患者（24.4%）出现术后并发症。9例患者总体需要进行翻修手术。
通过使用解剖预塑形且角度稳定的锁定加压接骨板远端肱骨钢板系统，大多数患者实现了允许早期物理治疗的稳定骨固定。由于早期开始物理治疗，功能结果可能得到改善。尽管使用了锁定加压接骨板系统，肱骨远端骨折部位仍频繁出现并发症，这突出了手术的挑战性，并表明需要进一步改进植入物和手术方法。
