Ellwein Alexander, Lill Helmut, Voigt Christine, Wirtz Pauline, Jensen Gunnar, Katthagen Jan Christoph
Traumatology and Reconstructive Surgery, Diakoniekrankenhaus Friederikenstift GmbH, Humboldtstr 5, 30169, Hannover, Germany,
Int Orthop. 2015 Apr;39(4):747-54. doi: 10.1007/s00264-014-2635-0. Epub 2014 Dec 23.
The purpose of this study was to evaluate and compare the results after double locking plate osteosynthesis (ORIF) and total elbow arthroplasty (TEA) in AO type C fractures of the distal humerus.
This retrospective study includes clinical results of 29 patients (9xTEA, 20xORIF) with a mean age of 62 years. The male to female ratio was 8:21. Range of motion, MEPS, DASH and complications were evaluated. Patients older than 60 years (n = 19) were filtered and compared statistically.
After a mean follow-up of 25 months the ORIF-group reached an extension-flexion of 99°±23° and the TEA-group of 111°±13°. The ORIF-group vs. the TEA-group had a mean MEPS of 85±17 vs. 94±11 and DASH of 34±24 vs. 24±12. In patients older than 60 years extension-flexion was 97°±23° after ORIF and 110°±14 after TEA (p = 0.237). The ORIF-group vs. the TEA-group had a mean MEPS of 82±21 vs. 94±11 (p = 0.078) and DASH of 45±18 vs. 26±11 (p = 0.023). The ORIF-group had a 4.4 times higher risk for major complications.
TEA and ORIF lead to comparable functional results, but major complications are more common after ORIF. Despite this, ORIF remains the gold standard for younger and older patients because of the lifelong loading limitation after TEA, unknown implant survival and problematic revision surgery. For patients older than 60 years a primary TEA can be recommended in exceptional cases, if the loading limitation is acceptable for the individual or the fracture is not reconstructable.
本研究旨在评估和比较双锁定钢板接骨术（切开复位内固定术，ORIF）和全肘关节置换术（TEA）治疗肱骨远端AO C型骨折后的结果。
这项回顾性研究纳入了29例平均年龄62岁的患者（9例行TEA，20例行ORIF）。男女比例为8:21。评估了活动范围、梅奥肘关节功能评分（MEPS）、上肢功能障碍评分（DASH）及并发症情况。对年龄大于60岁的患者（n = 19）进行筛选并进行统计学比较。
平均随访25个月后，ORIF组的屈伸活动度为99°±23°，TEA组为111°±13°。ORIF组与TEA组的平均MEPS分别为85±17和94±11，DASH分别为34±24和24±12。在年龄大于60岁的患者中，ORIF术后屈伸活动度为97°±23°，TEA术后为110°±14°（p = 0.237）。ORIF组与TEA组的平均MEPS分别为82±21和94±11（p = 0.078），DASH分别为45±18和26±11（p = 0.023）。ORIF组发生主要并发症的风险高4.4倍。
TEA和ORIF可带来相当的功能结果，但ORIF术后主要并发症更为常见。尽管如此，由于TEA术后存在终身负荷限制、植入物存活情况不明及翻修手术存在问题，ORIF仍是年轻和老年患者的金标准。对于年龄大于60岁的患者，在特殊情况下，如果个体能接受负荷限制或骨折无法重建，可推荐一期行TEA。
