Moghaddam-Alvandi A, Dremel E, Güven F, Heppert V, Wagner C, Studier-Fischer S, Grützner P A, Biglari B
Klinik für Orthopädie und Unfallchirurgie, Berufsgenossenschaftliche Unfallklinik Ludwigshafen, Unfallchirurgische Klinik an der Universität Heidelberg, Ludwig-Guttmann-Str. 13, 67071, Ludwigshafen, Deutschland.
Unfallchirurg. 2010 Apr;113(4):300-7. doi: 10.1007/s00113-009-1722-y.
Arthrodesis of the elbow joint (EA) is a rare salvage procedure which is disliked by both surgeons and patients. The aim of this study was to analyze the indications, the operation techniques and the outcome of EA in patients treated at our clinic. Between January 1997 and December 2005 a total of 20 patients with a mean age of 55 years (range 27-85 years) were treated with EA at our clinic. In 18 patients a compression plate was used as surgical technique. In 18 out of the 20 patients the operation was performed post-traumatically after infection, bone and tissue defects and painful loss of motion. Of these patients, 16 could be followed up for an average time of 66 months. The outcome was evaluated based on the degree of pain, range of motion, radiographic findings and grip strength measured with the Jamar dynamometer. All patients had a solid and fused EA, the average angle was 89 degrees (range 80-110 degrees) and the grip strength was reduced by 27% compared to the unaffected side. The patients achieved 56 points in the Morrey score, 38.29 points in the DASH (disabilities of the arm, shoulder and hand) score and 80 points in the Constant-Murley score. The indication of EA depends on several factors, therefore it is essential to take the patients' functional requirements into consideration and the best arthrodesis angle should be validated pre-operatively. In these cases the patients can regain good grip strength and a high level of stability within defined functional limitations.
肘关节融合术(EA)是一种罕见的挽救性手术,外科医生和患者都不太喜欢这种手术。本研究的目的是分析我院接受EA治疗患者的手术指征、手术技术及治疗结果。1997年1月至2005年12月期间,我院共对20例平均年龄55岁(范围27 - 85岁)的患者实施了EA手术。18例患者采用加压钢板作为手术技术。20例患者中有18例在创伤后因感染、骨与组织缺损以及疼痛性活动丧失而接受手术。其中16例患者得到随访,平均随访时间为66个月。根据疼痛程度、活动范围、影像学表现以及使用Jamar握力计测量的握力对治疗结果进行评估。所有患者的肘关节均实现了牢固融合,平均角度为89度(范围80 - 110度),与未受影响侧相比,握力下降了27%。患者的Morrey评分为56分,DASH(上肢、肩部和手部功能障碍)评分为38.29分,Constant - Murley评分为80分。EA的手术指征取决于多种因素,因此必须考虑患者的功能需求,并且术前应确定最佳融合角度。在这些病例中,患者在明确的功能限制范围内可以恢复良好的握力和较高的稳定性。