Weber Marc Maximilian, Rausch Valentin, Leschinger Tim, Müller Lars Peter, Hackl Michael
Klinik und Poliklinik für Orthopädie, Unfallchirurgie und Plastisch-Ästhetische Chirurgie, Universitätsklinikum Köln (AöR), Kerpener Str. 62, 50937, Köln, Deutschland.
Oper Orthop Traumatol. 2024 Aug;36(3-4):159-166. doi: 10.1007/s00064-024-00852-y. Epub 2024 Jul 22.
The aim of the operation is to replace the articular surface of the distal humerus in cases of nonreconstructible fractures of the distal humerus.
Active patients with high functional requirements, in whom weight limitation of total elbow arthroplasty should be avoided.
Contraindications include fractures with irreconstructible epicondyles and/or irreconstructible collateral ligaments, as well as ulnohumeral, or radiohumeral osteoarthritis.
Following subcutaneous anterior transposition of the ulnar nerve, surgical dislocation of the elbow joint is achieved through a paratricipital approach with release of the soft tissue structures from the humerus. After resection of the trochlea, the intramedullary canal of the humerus is prepared using rasps in order to implant the hemiprosthesis with retrograde cementing. Finally, the medial and lateral collateral ligaments as well as the flexors and extensors are repaired.
Early functional rehabilitation in a hinged elbow orthosis while avoiding varus/valgus stress after wound healing is completed.
Between 2018 and 2022, 18 patients with coronal shear fractures were treated with elbow hemiarthroplasty. The mean Mayo Elbow Performance Score (MEPS) was 79 (70-95) after a mean follow-up of 12 months. The mean range of motion was 99° (70-130°) in extension-flexion and 162° (90-180°) in pronation-supination.
该手术的目的是在肱骨远端骨折无法重建的情况下，替换肱骨远端的关节面。
功能需求高的活跃患者，应避免全肘关节置换术的重量限制。
禁忌症包括髁上骨折无法重建和/或侧副韧带无法重建，以及尺肱关节或桡肱关节骨关节炎。
在尺神经皮下前移位后，通过经三头肌旁入路，从肱骨上松解软组织结构，实现肘关节的手术脱位。切除滑车后，使用锉刀准备肱骨的髓内通道，以便逆行骨水泥固定植入半关节假体。最后，修复内侧和外侧副韧带以及屈肌和伸肌。
伤口愈合后，在带铰链的肘关节矫形器中进行早期功能康复，同时避免内翻/外翻应力。
2018年至2022年期间，18例冠状面剪切骨折患者接受了肘关节半关节置换术。平均随访12个月后，平均梅奥肘关节功能评分（MEPS）为79（70-95）。屈伸平均活动范围为99°（70-130°），旋前-旋后平均活动范围为162°（90-180°）。
