Solarino Giuseppe, Vicenti Giovanni, Abate Antonella, Carrozzo Massimiliano, Picca Girolamo, Moretti Biagio
Orthopaedic Section, Department of Basic Medical Sciences, Neurosciences and Sensory Organs, University of Bari "Aldo Moro", Bari, Italy.
Orthopaedic and Trauma Department, University of Foggia, Foggia, Italy.
Aging Clin Exp Res. 2015 Oct;27 Suppl 1:S77-83. doi: 10.1007/s40520-015-0425-1. Epub 2015 Jul 28.
To evaluate the clinical outcomes of radial head excision for multifragmentary radial head fracture in patients over 65 years old.
We retrospectively examined 30 patients over 65 years of age treated with radial head excision for comminuted radial head fractures. Patients were evaluated through clinical examinations, administrative questionnaires (DASH--Disabilities of the Arm, Shoulder and Hand; MEPS--Mayo Elbow Performance Score, VAS--Visual Analog Scale) and plain films.
The mean follow-up was 40 months (range 24-72 months); 27 out of 30 patients claimed to be satisfied. The mean DASH score was 13 (range 3-45.8) and mean MEPS was 79 (range 65-97). The radiographic evaluation showed 21 cases of elbow arthritis; only two of them complained about pain. Heterotopic ossification was evident in six cases with functional impairment in only one patient. Six patients with increased ulnar variance had clinical distal radio-ulnar joint instability.
Radial head excision has been considered a safe surgical procedure with satisfactory clinical outcomes. Development in biomechanical studies and prosthetic replacement of the radial head question the validity of radial head excision. In current literature, there are neither long-term follow-up studies on radial head prosthesis outcomes nor studies which consider elderly patient samples.
Radial head resection remains a good option when a radial head fracture occurs in elderly patients, taking into account the influence of poor bone quality and comorbidities on the outcome. Radial head excision is not indicated in the presence of associated lesions, because of the risk of residual elbow instability; complications associated with advanced age must be considered and a strict follow-up granted.
评估65岁以上患者多碎片型桡骨头骨折行桡骨头切除术的临床疗效。
我们回顾性研究了30例65岁以上因粉碎性桡骨头骨折接受桡骨头切除术的患者。通过临床检查、管理问卷（DASH——上肢、肩部和手部功能障碍；MEPS——梅奥肘关节功能评分；VAS——视觉模拟评分）和平片对患者进行评估。
平均随访时间为40个月（范围24 - 72个月）；30例患者中有27例表示满意。平均DASH评分为13（范围3 - 45.8），平均MEPS为79（范围65 - 97）。影像学评估显示21例肘关节关节炎；其中只有2例抱怨疼痛。6例出现异位骨化，仅1例患者有功能障碍。6例尺骨变异增加的患者临床出现远侧桡尺关节不稳定。
桡骨头切除术一直被认为是一种安全的手术方法，临床疗效令人满意。生物力学研究和桡骨头假体置换的发展对桡骨头切除术的有效性提出了质疑。在当前文献中，既没有关于桡骨头假体长期随访结果的研究，也没有考虑老年患者样本的研究。
考虑到骨质不佳和合并症对结果的影响，老年患者发生桡骨头骨折时，桡骨头切除术仍是一个不错的选择。存在相关损伤时不建议行桡骨头切除术，因为有残留肘关节不稳定的风险；必须考虑与高龄相关的并发症并进行严格随访。
