Heijink Andras, Wagener Marc L, de Vos Maarten J, Eygendaal Denise
Department of Orthopaedic Surgery, Academic Medical Center (AMC), Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands.
Department of Orthopaedic Surgery, Amphia Hospital, Breda, The Netherlands.
Strategies Trauma Limb Reconstr. 2015 Aug;10(2):101-8. doi: 10.1007/s11751-015-0229-z. Epub 2015 Aug 27.
Treatment of comminuted distal humeral fractures remains challenging. Open reduction-internal fixation remains the preferred treatment, but is not always feasible. In selected cases with non-reconstructable or highly comminuted fractures, total elbow arthroplasty has been used, however, also with relatively high complication and failure rates. Distal humerus prosthetic hemiarthroplasty (DHA) may be an alternative in these cases. The purpose of this study was to report the midterm results of six patients that were treated by DHA for acute and salvage treatment of non-reconstructable fractures of the distal humerus. All six patients were treated by DHA for acute and salvage treatment of non-reconstructable fractures of the distal humerus. Medical records were reviewed, and each patient was seen in the office. Mean follow-up was 54 months (range 21-76 months). Implant survival was 100 %. Three were pain free and three had mild or moderate residual pain. Average flexion-extension arc was 95.8° (range 70°-115°) and average pronation-supination arc was 165° (range 150°-180°). In three, there was some degree of instability, which was symptomatic in one. One had motoric and sensory sequelae of a partially recovered traumatic ulnar nerve lesion. According to the Mayo Elbow Performance Score, there were three excellent, one good and two poor results. Four were satisfied with the final result, and two were not. In this case series of six patients with DHA for non-reconstructable distal humerus fractures, favorable midterm follow-up results were seen; however, complications were also observed.
肱骨远端粉碎性骨折的治疗仍然具有挑战性。切开复位内固定仍然是首选的治疗方法，但并非总是可行。在某些不可重建或高度粉碎性骨折的病例中，已采用全肘关节置换术，然而，其并发症和失败率也相对较高。在这些病例中，肱骨远端假体半关节成形术（DHA）可能是一种替代方法。本研究的目的是报告6例接受DHA治疗肱骨远端不可重建骨折的急性和挽救性治疗患者的中期结果。所有6例患者均接受DHA治疗肱骨远端不可重建骨折的急性和挽救性治疗。回顾了病历，并在门诊对每位患者进行了检查。平均随访时间为54个月（范围21 - 76个月）。植入物存活率为100%。3例无疼痛，3例有轻度或中度残余疼痛。平均屈伸弧度为95.8°（范围70° - 115°），平均旋前旋后弧度为165°（范围150° - 180°）。3例存在一定程度的不稳定，其中1例有症状。1例有部分恢复的创伤性尺神经损伤的运动和感觉后遗症。根据梅奥肘关节功能评分，结果为3例优秀，1例良好，2例差。4例对最终结果满意，2例不满意。在这个由6例接受DHA治疗不可重建肱骨远端骨折的病例系列中，观察到了良好的中期随访结果；然而，也观察到了并发症。
