Celli Andrea, Ricciarelli Marco, Guerra Enrico, Bonucci Pierluigi, Ritali Alice, Cavallo Marco, Rotini Marco, Rotini Roberto
Shoulder and Elbow Unit, Department of Orthopaedic Surgery, Hesperia Hospital, Modena, Italy.
Shoulder and Elbow Unit, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy.
J Shoulder Elbow Surg. 2022 May;31(5):1015-1025. doi: 10.1016/j.jse.2021.12.030. Epub 2022 Jan 26.
The earliest distal humeral hemiarthroplasty (or elbow hemiarthroplasty [EHA]) implants, which date back to the late 1940s, were performed in patients with severe elbow joint injuries as an alternative to arthrodesis. After some clinical reports and case studies with a short follow-up, published in the 1990s, a new "anatomically convertible" EHA model was introduced in 2005 and became a common surgical option to treat complex elbow fractures and their sequelae. We describe the mid- and long-term outcomes of EHA performed to treat acute intra-articular fractures or their sequelae.
From 2006 to 2017, 51 patients underwent EHA for acute intra-articular fractures or their sequelae. A total number of 41 patients (80.5% female) with a minimum follow-up of 2 years, 24 with acute lesions and 17 with sequelae, were identified retrospectively. Clinical evaluation was according to the Disabilities of the Arm, Shoulder, and Hand (DASH) score (subjective), and the Oxford Elbow Score (OES) and Mayo Elbow Performance Score (MEPS) (objective). Radiographic follow-up was with standard radiographs.
Mean follow-up was 92.2 months (range, 24-151). Mean patient age at surgery was 62.8 years (range, 45-81). The mean MEPS was 87.1 points, with excellent results in 26 cases, good results in 9 cases, fair in 2, and poor results in 4. The mean DASH score was 15.9 and the mean OES was 40.5, with satisfactory results in 30 cases. Twenty patients experienced complications and 2 required revision surgery.
EHA is a valuable surgical option in selected patients with comminuted distal humeral joint fractures that cannot be reconstructed with stable fixation and in those with malunion of the articular surface of the humerus. EHA offers potential advantages, especially in active elderly patients and in those aged less than 70 years. It is essential to achieve joint stability, restoring medial and lateral ligament function besides the integrity of the coronoid process. An intact olecranon surface without signs of degenerative changes is also critical for EHA success.
Our mid- and long-term experience with EHA is favorable, with a high proportion of satisfactory results and long survival rates for both lesion types. In selected patients with acute and post-traumatic injuries, EHA is a valuable surgical option.
最早的肱骨远端半关节置换术（或肘关节半关节置换术[EHA]）植入物可追溯到20世纪40年代末，用于严重肘关节损伤患者，作为关节融合术的替代方案。在20世纪90年代发表了一些短期随访的临床报告和病例研究后，2005年引入了一种新的“解剖学可转换”EHA模型，成为治疗复杂肘关节骨折及其后遗症的常见手术选择。我们描述了EHA治疗急性关节内骨折或其后遗症的中长期结果。
2006年至2017年，51例患者因急性关节内骨折或其后遗症接受了EHA手术。回顾性确定了41例患者（80.5%为女性），最小随访时间为2年，其中24例为急性损伤，17例为后遗症。临床评估依据手臂、肩部和手部功能障碍（DASH）评分（主观）以及牛津肘关节评分（OES）和梅奥肘关节功能评分（MEPS）（客观）。影像学随访采用标准X线片。
平均随访时间为92.2个月（范围24 - 151个月）。手术时患者平均年龄为62.8岁（范围45 - 81岁）。平均MEPS为87.1分，其中26例结果为优，9例为良，2例为中，4例为差。平均DASH评分为15.9分，平均OES为40.5分，30例结果满意。20例患者出现并发症，2例需要翻修手术。
EHA对于无法通过稳定固定重建的肱骨远端粉碎性关节骨折患者以及肱骨关节面畸形愈合患者是一种有价值的手术选择。EHA具有潜在优势，尤其在活跃的老年患者和70岁以下患者中。除了冠状突的完整性外，实现关节稳定性并恢复内外侧韧带功能至关重要。完整的鹰嘴表面且无退变迹象对于EHA的成功也很关键。
我们对EHA的中长期经验良好，两种损伤类型的满意结果比例高且生存率长。对于选定的急性和创伤后损伤患者，EHA是一种有价值的手术选择。
