Jenkins Christopher W, Edwards Gray Ad, Chalk Naomi, McCann Philip A, Amirfeyz Rouin
Department of Orthopaedic Surgery, Bristol Royal Infirmary, Bristol, UK.
Shoulder Elbow. 2022 Feb;14(1):85-94. doi: 10.1177/1758573220977768. Epub 2020 Dec 15.
We assessed distal humeral column preservation effects on clinical, radiographic and patient reported outcomes following distal humerus hemiarthroplasty for acute unreconstructable fractures.
Thirty-seven consecutive patients (mean age, 75; range, 29-93 years) with an average follow-up of 61 months (range, 24-105 months) after distal humerus hemiarthroplasty using a triceps preserving approach were studied. QuickDASH and Oxford Elbow Score assessed patient reported outcomes. Clinical and radiographic assessments comprised range of motion, grip strength, instability, implant loosening, chondral wear, heterotopic ossification and condylar union.
Average QuickDASH was 14.9 (range, 0-63) and Oxford Elbow Score 40.35 (range, 25-48). Mean flexion arc was 108°, extension deficit 17° and pronosupination arc 155°. Average operative sided grip strength was 31.05 kg versus 31.13 kg contralaterally. Column preservation had no statistically significant effect on QuickDASH ( = 0.75), Oxford Elbow Score ( = 0.78), flexion-extension ( = 0.87), pronosupination ( = 0.78) or grip strength ( = 0.87). No progressive radiographic loosening or symptomatic chondral wear occurred. All fixed columns united. Three cases of immediate post-operative laxity fully resolved on elbow mobilisation. Four post-operative complications required further surgery: one ulnar neuropathy, one heterotopic ossification, one wound breakdown and one traumatic dislocation.
Medium-term outcome of distal humerus hemiarthroplasty for acute unreconstructable distal humeral fractures is reliable irrespective of condylar preservation.
我们评估了在急性不可重建性骨折行肱骨头半关节置换术后，肱骨远端柱保留对临床、影像学及患者报告结局的影响。
采用保留肱三头肌入路对37例连续患者（平均年龄75岁；范围29 - 93岁）进行肱骨头半关节置换术，平均随访61个月（范围24 - 105个月）。采用QuickDASH和牛津肘关节评分评估患者报告结局。临床和影像学评估包括活动范围、握力、不稳定、植入物松动、软骨磨损、异位骨化和髁联合。
平均QuickDASH为14.9（范围0 - 63），牛津肘关节评分为40.35（范围25 - 48）。平均屈曲弧为108°，伸展缺失为17°，旋前旋后弧为155°。患侧平均手术侧握力为31.05 kg，对侧为31.13 kg。柱保留对QuickDASH（P = 0.75）、牛津肘关节评分（P = 0.78）、屈伸（P = 0.87）、旋前旋后（P = 0.78）或握力（P = 0.87）无统计学显著影响。未发生渐进性影像学松动或有症状的软骨磨损。所有固定柱均愈合。3例术后即刻松弛在肘关节活动后完全缓解。4例术后并发症需要进一步手术：1例尺神经病变、1例异位骨化、1例伤口裂开和1例创伤性脱位。
对于急性不可重建性肱骨远端骨折行肱骨头半关节置换术的中期结局是可靠的，与髁保留无关。
