Upper Limb Surgery Department, Hôpital de Hautepierre 2, Strasbourg University Hospital, Strasbourg, France.
Upper Limb Surgery Department, Hôpital de Hautepierre 2, Strasbourg University Hospital, Strasbourg, France.
J Shoulder Elbow Surg. 2024 Aug;33(8):1659-1664. doi: 10.1016/j.jse.2024.03.032. Epub 2024 May 6.
The primary objective of this study was to compare the clinical outcomes of total elbow arthroplasty as the index procedure in the treatment of traumatic distal humerus fractures with those of secondary total elbow arthroplasty after failed internal fixation. The secondary objective was to compare the complication rates and the radiographic results in the 2 groups. Our hypothesis was that the clinical results of total elbow arthroplasty performed after failed internal fixation were comparable to those of primary total elbow arthroplasty in the treatment of distal humerus fractures in the elderly population.
We conducted a retrospective cohort comparison study, including 60 patients with a median age of 80 years (71-85 years), who either underwent a primary total elbow arthroplasty (group 1; 45 patients) or secondary total elbow arthroplasty after failed internal fixation (group 2; 15 patients) in the treatment of a post-traumatic supra and intercondylar fracture of the distal humerus, between January 2004 and January 2021. The clinical examination, including the Mayo Elbow Performance Score and triceps proficiency test, complication rates, and the need for reoperation were noted. The average clinical and radiographic follow-up was 40.8 months (24-120 months).
The clinical results of the 2 groups were comparable when looking at the Mayo Elbow Performance Score (90.00 [85.00, 100.00], P = .486). With regard to complications, there were 2 surgical site infections in group 1 and 3 in group 2 (P = .099), 1 case of mechanical loosening of the humeral component in group 1 and 1 in group 2 (P = .448), and 1 patient with triceps insufficiency in group 1.
Secondary total elbow arthroplasty after failed internal fixation has shown good functional results and a complication rate comparable to that of index total elbow arthroplasty in the treatment of articular fractures of the distal humerus in the elderly.
本研究的主要目的是比较初次全肘关节置换术（primary total elbow arthroplasty，以下简称 TEA）与内固定失败后行二次 TEA 治疗创伤性肱骨远端骨折的临床疗效，并比较两组患者的并发症发生率和影像学结果。我们的假设是，对于老年人群肱骨远端骨折患者，TEA 治疗失败后行二次 TEA 的临床效果与初次 TEA 治疗效果相当。
我们进行了一项回顾性队列比较研究，纳入 2004 年 1 月至 2021 年 1 月期间因创伤性肱骨远端髁上和髁间骨折接受初次 TEA（n=45 例，组 1）或内固定失败后行二次 TEA（n=15 例，组 2）治疗的 60 例患者，患者的中位年龄为 80 岁（71-85 岁）。记录临床检查结果（包括 Mayo 肘关节功能评分和三头肌收缩力测试）、并发症发生率和再次手术情况。平均临床和影像学随访时间为 40.8 个月（24-120 个月）。
组间 Mayo 肘关节功能评分结果相似（组 1：90.00[85.00，100.00]；组 2：90.00[85.00，100.00]；P=0.486）。在并发症方面，组 1 有 2 例发生手术部位感染，组 2 有 3 例（P=0.099）；组 1 有 1 例肱骨干假体松动，组 2 有 1 例（P=0.448）；组 1 有 1 例出现三头肌收缩力不足。
对于老年人群肱骨远端关节内骨折患者，TEA 治疗失败后行二次 TEA 可获得良好的功能效果，且并发症发生率与初次 TEA 治疗效果相当。
