St. James's Hospital, Dublin, Ireland.
Midlands Regional Hospital Tullamore, Tullamore, Ireland.
J Shoulder Elbow Surg. 2022 Jul;31(7):1545-1552. doi: 10.1016/j.jse.2022.02.015. Epub 2022 Mar 23.
In patients with distal humerus fractures that are unreconstructible, total elbow arthroplasty is an established alternative to open reduction-internal fixation. Distal humerus hemiarthroplasty is a further alternative to avoid the significant lifestyle limitations associated with total elbow arthroplasty. Distal humerus hemiarthroplasty is an increasingly popular treatment option for unreconstructible distal humeral fractures not amenable to reconstruction. The aim of this systematic review was to assess the literature regarding the functional outcomes and complications of the use of distal humerus hemiarthroplasty for acute trauma.
A systematic review of the PubMed, Embase, and Scopus databases was performed. The search terms included "distal humerus fracture" OR "elbow fracture" AND "hemiarthroplasty" OR "arthroplasty" OR "replacement." Studies were limited to those published in the English language with reported functional outcome measures and complications. Patient demographic characteristics, implant systems, clinical outcomes (range of motion and functional outcome scores), and complications were extracted.
Thirteen studies with a total of 207 patients met the inclusion criteria. The average age ranged from 44 to 79 years, with the mean length of follow-up ranging from 11 to 82 months postoperatively. A mean range-of-motion arc ≥ 93° was achieved in all studies, with 11 of 13 studies achieving mean functional range of motion ≥ 100°. All studies reported good to excellent mean outcome scores. Heterotopic ossification, ulnar cartilage wear, stiffness, and ulnar neuropathy were the most commonly encountered complications. The reoperation rate and revision rate were 17% and 3%, respectively.
Distal humerus hemiarthroplasty is a viable option in the treatment of unreconstructible distal humerus fractures, with good to excellent outcomes expected. Long-term outcome data and the use of distal humerus hemiarthroplasty in younger patients are yet to be fully defined.
在无法重建的肱骨远端骨折患者中，全肘关节置换术是一种成熟的替代开放复位内固定术的方法。肱骨远端半关节置换术是另一种选择，可以避免与全肘关节置换术相关的显著生活方式限制。肱骨远端半关节置换术是一种越来越受欢迎的治疗方法，适用于无法重建的肱骨远端骨折。本系统评价的目的是评估有关肱骨远端半关节置换术治疗急性创伤的文献，以评估其功能结果和并发症。
对 PubMed、Embase 和 Scopus 数据库进行系统评价。检索词包括“肱骨远端骨折”或“肘部骨折”和“半关节置换术”或“关节置换术”或“置换术”。研究仅限于以报告功能结果测量和并发症的英语发表的研究。提取患者人口统计学特征、植入物系统、临床结果（活动范围和功能结果评分）和并发症。
符合纳入标准的 13 项研究共纳入 207 例患者。平均年龄为 44 至 79 岁，平均术后随访时间为 11 至 82 个月。所有研究均达到了平均活动范围≥93°，13 项研究中有 11 项达到了平均功能活动范围≥100°。所有研究报告的平均结果评分均为良好至优秀。异位骨化、尺侧软骨磨损、僵硬和尺神经病变是最常见的并发症。再次手术率和翻修率分别为 17%和 3%。
肱骨远端半关节置换术是治疗无法重建的肱骨远端骨折的可行选择，预期效果良好至优秀。长期结果数据和在年轻患者中使用肱骨远端半关节置换术仍有待充分定义。
