Fritsche C C, Deml O, Großstück R, Hofmann G O
Klinik für Unfall- und Wiederherstellungschirurgie, BG-Kliniken Bergmannstrost, Halle (Saale).
Z Orthop Unfall. 2015 Jun;153(3):267-76. doi: 10.1055/s-0034-1396229. Epub 2015 May 20.
Treatment of distal humerus fractures by open reduction and internal fixation, especially in elderly patients, does not always result in satisfactory outcomes. Previous studies show good outcomes in total joint replacement of these fractures. The objective of this study is to present our experience with primary and secondary implantation of a semiconstrained elbow prosthesis after trauma.
In two study centers, between 2003 and 2009, a total of 44 patients (34 women and 10 men) with an average age of 65 years were treated primarily (n = 19) or secondarily (n = 25) by semiconstrained total elbow replacement after distal humerus fractures. Primary treatment referred exclusively to 13C2 and 13C3 fractures according to the AO/ASIF-classification, except for two cases. Indications for secondary elbow arthroplasty were post-traumatic arthrosis (n = 10), non-union of the bone (n = 6), failed osteosynthesis (n = 5), post-traumatic chronic luxation (n = 2) and severe bony defect situation after chronic osteitis (n = 2). In two cases a prostheses exchange for a periprosthetic fracture after fall was performed. Clinical outcome was radiologically controlled and measured by the use of the Mayo Elbow Performance Score (MEPS) and DASH score after a mean follow-up of 38 (13 to 96) months.
33 Patients (75 %) had a follow-up examination clinically and radiologically. Mayo Elbow Performance Score was excellent or good in 27 (82 %) cases with a mean of 87 points (primary group 87 vs. secondary group 86). The average DASH score was 28 points (primary group 24 vs. secondary group 32). The flexion was on average 131° (110 to 145°), the extension deficit 30° (0 to 80°) to neutral position and the range of motion was 100° (40 to 145°) (primary group 102° vs. secondary group 97°). The mean operation time was 141 (100 to 250) minutes (primary group 138 vs. secondary group 144 min.). The length of stay in hospital was on average 15 days. Complications occurred due to ulnar paresthesia (n = 4), deep infection (n = 6), periprosthetic ulna fracture (n = 1), heterotopic ossifications requiring intervention (n = 1), elbow stiffness (n = 1), triceps insufficiency (n = 5) and triceps avulsion (n = 2).
Primary elbow joint replacement seems to be a promising alternative for distal humerus fractures without a sufficient reconstruction opportunity, showing encouraging short- and medium-term results in the elderly. Secondary replacement can achieve satisfying results in failed osteosynthesis, non-union of the bone or post-traumatic arthrosis as well. The rate of complications and revisions is high.
采用切开复位内固定治疗肱骨远端骨折，尤其是老年患者，其疗效并不总是令人满意。既往研究表明，对这些骨折进行全关节置换可取得良好疗效。本研究的目的是介绍我们在创伤后一期和二期植入半限制性肘关节假体的经验。
在2003年至2009年期间，两个研究中心共有44例患者（34例女性和10例男性），平均年龄65岁，接受了肱骨远端骨折后一期（n = 19）或二期（n = 25）半限制性全肘关节置换术。一期治疗仅涉及根据AO/ASIF分类的13C2和13C3骨折，有两例除外。二期肘关节置换的指征为创伤后关节炎（n = 10）、骨不连（n = 6）、内固定失败（n = 5）、创伤后慢性脱位（n = 2）以及慢性骨髓炎后的严重骨缺损情况（n = 2）。有两例因跌倒后假体周围骨折而进行了假体置换。临床疗效通过影像学检查进行评估，并在平均随访38（13至96）个月后使用梅奥肘关节功能评分（MEPS）和上肢功能障碍评分（DASH）进行测量。
33例患者（75%）接受了临床和影像学随访检查。梅奥肘关节功能评分在27例（82%）患者中为优或良，平均分为87分（一期组87分，二期组86分）。平均DASH评分为28分（一期组24分，二期组32分）。平均屈曲角度为131°（110至145°），伸直受限至中立位为30°（0至80°），活动范围为100°（40至145°）（一期组102°，二期组97°）。平均手术时间为141（100至250）分钟（一期组138分钟，二期组144分钟）。平均住院时间为15天。并发症包括尺神经感觉异常（n = 4）、深部感染（n = 6）、假体周围尺骨骨折（n = 1）、需要干预的异位骨化（n = 1）、肘关节僵硬（n = 1）、肱三头肌功能不全（n = 5）和肱三头肌撕脱（n = 2）。
对于没有足够重建机会的肱骨远端骨折，一期肘关节置换似乎是一种有前景的替代方法，在老年患者中显示出令人鼓舞的短期和中期结果。二期置换在骨折内固定失败、骨不连或创伤后关节炎中也能取得满意的结果。并发症和翻修率较高。
