Service d'orthopédie-traumatologie, institut de l'appareil locomoteur, CHU Purpan, place du Dr-Baylac, 31059 Toulouse, France.
Orthop Traumatol Surg Res. 2013 Nov;99(7):779-84. doi: 10.1016/j.otsr.2013.08.003. Epub 2013 Oct 3.
Fractures of the distal humerus represent 5% of osteoporosis fragility fractures in subjects over the age of 60. Osteoporosis, comorbidities and intra-articular comminution make management of this entity difficult.
The hypothesis was that total elbow arthroplasty could be a reliable treatment option in subjects over the age of 65 presenting with a fracture of the distal humerus.
Eight-seven patients (80 women and 7 men) mean age 79 years old (65-93) underwent total elbow arthroplasty for the treatment of an AO type A fracture in 9 cases, type B in 8 and type C in 70.
After a mean follow-up of 37.5 months (6-106) the Mayo Elbow Performance Score MEPS was 86±14, the quick-DASH score was 24±19 and the Katz score was 5±1.5 points. The MEPS was better in patients with a high preoperative Katz score and a history of inflammatory arthritis who were living at home. Fifty-five patients (63%) presented with a pain-free elbow, and 20 (24%) with slight pain. The flexion-extension range of motion was 97±22° and 48% presented with a flexion-extension arc of at least 100°. Function was normal in 69 patients. Complications were identified in 20 cases (23%) and revision surgery was necessary in 8 (9%). Two arthroplasties had to be changed, one for a fracture of the humeral stem component and the other for loosening. Only one infection occurred in this series.
Total elbow arthroplasties provide fractured patients with immediate satisfactory results and a stable, painless and functional elbow. These results seem to be reliable and durable. The rate of complications is low with revision surgery in approximately 10%.
Level IV.
肱骨远端骨折占 60 岁以上骨质疏松脆性骨折的 5%。骨质疏松症、合并症和关节内粉碎性骨折使此类疾病的治疗变得困难。
对于 65 岁以上因肱骨远端骨折就诊的患者，全肘关节置换术可能是一种可靠的治疗选择。
87 例患者（80 例女性和 7 例男性），平均年龄 79 岁（65-93 岁），9 例为 AO 型 A 骨折，8 例为 B 型骨折，70 例为 C 型骨折，行全肘关节置换术治疗。
平均随访 37.5 个月（6-106 个月）后，Mayo 肘关节功能评分（MEPS）为 86±14，快速残疾指数（DASH）评分为 24±19，Katz 评分为 5±1.5 分。术前 Katz 评分高、有炎症性关节炎病史、居家生活的患者 MEPS 更好。55 例（63%）患者肘部无痛，20 例（24%）患者轻度疼痛。屈伸活动范围为 97±22°，48%患者屈伸活动弧至少为 100°。69 例患者功能正常。20 例（23%）出现并发症，8 例（9%）需要翻修手术。2 例假体更换，1 例为肱骨柄组件骨折，另 1 例为松动。本系列仅发生 1 例感染。
全肘关节置换术可为骨折患者提供即刻满意的结果，并获得稳定、无痛和功能良好的肘部。这些结果似乎是可靠和持久的。并发症发生率低，约 10%需要翻修手术。
IV 级。
