Bhashyam Abhiram R, Jupiter Jesse B
Massachusetts General Hospital, Department of Orthopaedics, Boston, MA, USA.
Research performed at Massachusetts General Hospital, Boston, MA, USA.
Arch Bone Jt Surg. 2019 May;7(3):251-257.
The purpose of this retrospective study was to analyze the long-term results of revision ORIF, joint contracture release, and autogenous bone-grafting in the treatment of distal humerus frac-ture nonunions in older aged patients with poor bone quality or bone loss who would have been candidates for total elbow arthroplasty.
Seven patients (average age at index procedure: 53.3 years, range: 41-75) with a distal humerus fracture nonunion treated with revision ORIF, joint contracture release and autogenous bone grafting between 1989-2000 were available for follow-up. Radiographic union and arthrosis were assessed using the most recent radiograph. Pain-related outcomes were measured using PROMIS Pain Interference scores. Functional outcomes were evaluated using the Mayo Elbow Perfor-mance Index (MEPI).
After an average follow-up of 22 years (range: 19-27 years), all nonunions were healed after the index procedure and had an average arc of ulnohumeral motion of 80°, flexion of 112°, and flex-ion contracture of 32°. Average arthrosis grade was moderate joint-space narrowing with osteo-phyte formation. One patient had exertional discomfort but none required chronic pain medica-tions. PROMIS-Pain Interference scores were no different than the general population (mean [95%CI] = 49.2 [41.8, 56.6], ). Per the MEPI, the functional result was excellent in five patients, good in one, and poor in one.
Despite older age and worse bone quality, distal humerus fracture nonunions can be treated using revision ORIF, joint contracture release and autogenous bone-grafting with acceptable long-term outcomes.
IV.
本回顾性研究的目的是分析翻修切开复位内固定术、关节挛缩松解术和自体骨移植治疗老年肱骨远端骨折不愈合的长期结果，这些患者骨质质量差或骨质流失，原本是全肘关节置换术的候选者。
1989年至2000年间，7例接受翻修切开复位内固定术、关节挛缩松解术和自体骨移植治疗的肱骨远端骨折不愈合患者（初次手术时平均年龄：53.3岁，范围：41 - 75岁）可供随访。使用最新的X线片评估影像学愈合和关节病情况。使用患者报告结果测量信息系统（PROMIS）疼痛干扰评分来衡量与疼痛相关的结果。使用梅奥肘关节功能指数（MEPI）评估功能结果。
平均随访22年（范围：19 - 27年）后，所有骨折不愈合在初次手术后均愈合，尺肱关节平均活动弧为80°，屈曲112°，屈曲挛缩32°。平均关节病分级为中度关节间隙变窄伴骨赘形成。1例患者有劳累时不适，但无人需要长期服用止痛药物。PROMIS疼痛干扰评分与普通人群无差异（均值[95%置信区间]=49.2[41.8,56.6]）。根据MEPI，5例患者功能结果优秀，1例良好，1例差。
尽管患者年龄较大且骨质质量较差，但肱骨远端骨折不愈合可通过翻修切开复位内固定术、关节挛缩松解术和自体骨移植进行治疗，并获得可接受的长期结果。
IV级。
