Department of Orthopaedic Surgery, University of Arizona College of Medicine, Phoenix, AZ, USA; The CORE Institute, Phoenix, AZ, USA.
Division of Orthopaedic Surgery, Department of Surgery, University of Alberta, Edmonton, AB, Canada.
J Shoulder Elbow Surg. 2019 Nov;28(11):2198-2204. doi: 10.1016/j.jse.2019.06.004. Epub 2019 Aug 21.
Total elbow arthroplasty (TEA) is a reliable treatment for elderly patients with comminuted intra-articular distal humeral fractures. However, the longevity and long-term complications associated with this procedure are unknown. The objectives of this study were to examine long-term outcomes and implant survival in elderly patients undergoing TEA for fracture.
Patients from a previously published randomized controlled trial of 42 patients in which TEA was compared with open reduction-internal fixation (ORIF) were followed up long term. Patients were aged 65 years or older with comminuted intra-articular distal humeral fractures. Outcomes included patient-reported grading of function and pain, revision surgical procedures, and implant survival.
Data were obtained for 40 patients, 15 treated with ORIF and 25 treated with TEA, with a mean follow-up period of 12.5 years for surviving patients and 7.7 years for deceased patients. The reoperation rate was 3 of 25 in the TEA group and 4 of 15 in the ORIF group (P = .39). Of the 25 patients with TEAs, only 1 required (early) revision arthroplasty; 7 were living with their original arthroplasty, and 15 died with a well-functioning implant in situ. Three were lost to follow-up.
TEA is an effective and reliable procedure for the treatment of comminuted distal humeral fractures in the elderly patient. Our study reveals reliable implant long-term survival, with no patient requiring a late revision. For the majority of these patients, a well-performed TEA will give them a well-functioning elbow for life and will be the last elbow procedure required.
全肘关节置换术（TEA）是治疗粉碎性关节内肱骨远端骨折老年患者的可靠方法。然而，该手术的长期效果和长期并发症尚不清楚。本研究的目的是评估接受 TEA 治疗骨折的老年患者的长期疗效和假体生存率。
对先前发表的一项 42 例患者的随机对照试验中的患者进行了长期随访，该试验比较了 TEA 与切开复位内固定（ORIF）的疗效。患者年龄均在 65 岁以上，且为粉碎性关节内肱骨远端骨折。主要评估指标包括患者报告的功能和疼痛分级、翻修手术和假体生存率。
共获得 40 例患者的数据，15 例接受 ORIF 治疗，25 例接受 TEA 治疗，存活患者的平均随访时间为 12.5 年，死亡患者为 7.7 年。TEA 组的翻修率为 3 例，ORIF 组为 4 例（P =.39）。25 例 TEA 患者中，仅 1 例需要（早期）翻修关节置换术；7 例患者的关节假体仍在使用中，15 例患者死亡，其关节假体仍在位且功能良好。3 例患者失访。
TEA 是治疗老年粉碎性肱骨远端骨折的有效且可靠的方法。我们的研究表明假体具有可靠的长期生存率，无患者需要进行晚期翻修。对于大多数患者而言，TEA 能为其提供一个功能良好的肘关节，使他们的生活免受肘部疾病的困扰，这也是他们最后一次接受肘部手术。
