Müller L P, Wegmann K, Burkhart K J
Unfall-, Hand- und Ellenbogenchirurgie, Klinik und Poliklinik für Orthopädie und Unfallchirurgie, Universitätsklinikum Köln, Kerpener Straße 62, Köln, Germany.
Unfallchirurg. 2013 Aug;116(8):708-15. doi: 10.1007/s00113-013-2411-4.
The treatment of choice for fractures of the distal humerus is double plate osteosynthesis. Due to anatomical preshaped angle stable plates the primary stability and management of soft tissues has been improved. However, osteoporotic comminuted fractures in the elderly are often not amenable to stable osteosynthesis and total elbow arthroplasty has been established as an alternative therapy. Although complication rates have been reduced, complications of total elbow arthroplasty are still much more frequent than in total hip replacement. Furthermore, patients are advised not to exceed a weight bearing of 5 kg. Therefore, the indications for elbow arthroplasty must be evaluated very strictly and should be reserved for comminuted distal humeral fractures in the elderly with poor bone quality that are not amenable to stable osteosynthesis or for simple fractures in cases of preexisting symptomatic osteoarthritis. This article introduces and discusses modern concepts of elbow arthroplasty, such as modular convertible prosthesis systems, hemiarthroplasty and radial head replacement in total elbow arthroplasty.
肱骨远端骨折的首选治疗方法是双钢板接骨术。由于解剖预塑形角度稳定钢板，软组织的初始稳定性及处理得到了改善。然而，老年人的骨质疏松性粉碎性骨折往往不适合进行稳定的接骨术，全肘关节置换术已成为一种替代疗法。尽管并发症发生率有所降低，但全肘关节置换术的并发症仍比全髋关节置换术更为常见。此外，建议患者负重不超过5千克。因此，肘关节置换术的适应证必须非常严格地评估，应仅适用于骨质质量差、不适合进行稳定接骨术的老年肱骨远端粉碎性骨折，或适用于已有症状性骨关节炎病例的简单骨折。本文介绍并讨论了肘关节置换术的现代概念，如模块化可转换假体系统、半关节置换术以及全肘关节置换术中的桡骨头置换术。
