Stephens J D, Kohrs Brandon, Bushnell Logan, Gabriel Speros, Brent Bamberger H
Department of Orthopedics, Grandview Medical Center, Affiliate of Kettering Health Network and Ohio, University Heritage College of Osteopathic Medicine, Dayton, Ohio.
J Shoulder Elb Arthroplast. 2020 Nov 23;4:2471549220960052. doi: 10.1177/2471549220960052. eCollection 2020.
Distal humerus fractures not amenable to open reduction internal fixation (ORIF) present a unique dilemma, especially for patients that weight bear through assistive devices. The one accepted operative treatment for irreparable distal humerus fractures is total elbow arthroplasty (TEA). However, TEA commonly requires lifetime weight lifting restrictions and has limited long term results. Elbow hemiarthroplasty (EHA) represents an alternative treatment modality. This study reviews patients treated with EHA permitted to weight bear postoperatively.
Twelve patients underwent EHA for comminuted distal humerus fractures deemed non-reconstructable by ORIF. Patient survey data was collected retrospectively. All patients were allowed to weight bear as tolerated through the operative extremity. Outcome measures included Patient rated elbow evaluation (PREE), Mayo elbow performance score (MEPS), and whether revision surgery was required.
The average MEPS score was 76.1 indicating fair outcomes and the average PREE score was 41. One patient required revision. Average follow up was 44.1 months. Three patients required an assistive device prior to injury.
EHA serves as a viable option for non-reconstructable distal humerus fractures. EHA does not require a weight lifting restriction, which is a benefit over TEA. Overall, patients reported preserved functional capabilities but did report moderate pain. EHA demonstrated durability, although one patient required revision.
With growing interest in use of EHA, further studies are required to evaluate EHA as a superior treatment for patients with nonreconstructable traumatic distal humerus fractures; however, this study does support use in elderly patients with intermediate follow up.
难以进行切开复位内固定（ORIF）的肱骨远端骨折带来了独特的难题，对于使用辅助器械负重的患者而言尤为如此。对于无法修复的肱骨远端骨折，唯一被认可的手术治疗方法是全肘关节置换术（TEA）。然而，TEA通常需要终身限制提举重物，且长期效果有限。肘关节半关节成形术（EHA）是一种替代治疗方式。本研究回顾了接受EHA治疗且术后允许负重的患者。
12例患者因ORIF认为不可重建的肱骨远端粉碎性骨折接受了EHA治疗。回顾性收集患者调查数据。所有患者均被允许通过手术侧肢体耐受负重。结果指标包括患者自评肘关节评估（PREE）、梅奥肘关节功能评分（MEPS）以及是否需要翻修手术。
平均MEPS评分为76.1，表明结果尚可，平均PREE评分为41。1例患者需要翻修。平均随访时间为44.1个月。3例患者在受伤前需要辅助器械。
EHA是不可重建的肱骨远端骨折的一种可行选择。EHA不需要限制提举重物，这是优于TEA的一点。总体而言，患者报告功能能力得以保留，但确实报告有中度疼痛。EHA显示出耐久性，尽管有1例患者需要翻修。
随着对EHA应用的兴趣日益增加，需要进一步研究以评估EHA作为不可重建的创伤性肱骨远端骨折患者的更优治疗方法；然而，本研究确实支持在老年患者中进行中期随访时使用。
