Cobb T K, Morrey B F
Mayo Clinic, Rochester, Minnesota 55905, USA.
J Bone Joint Surg Am. 1997 Jun;79(6):826-32. doi: 10.2106/00004623-199706000-00004.
We retrospectively reviewed the results of primary total elbow arthroplasty for the treatment of an acute fracture of the distal aspect of the humerus in twenty consecutive patients (twenty-one elbows) who had a mean age of seventy-two years (range, forty-eight to ninety-two years) at the time of the injury. The patients were managed between November 1982 and October 1992. The presence of rheumatoid arthritis in nine patients (ten elbows) influenced the choice of treatment. The mean interval between the injury and the total elbow arthroplasty was seven days (range, one to twenty-five days). The mean duration of postoperative hospitalization was seven days (range, four to thirteen days). The mean duration of follow-up was 3.3 years (range, three months to 10.5 years). All patients were followed for a minimum of two years or until the time of death; the duration of follow-up was less than two years for three patients who died. None of the patients were lost to follow-up. Twenty implants were intact at the latest follow-up examination. One patient had a revision total elbow arthroplasty twenty months after the index procedure because of a fracture of the ulnar component sustained in a fall on the outstretched arm. On the basis of the Mayo elbow performance score, fifteen elbows had an excellent result and five had a good result; there were inadequate data for one elbow. There were no fair or poor results. The mean arc of flexion was 25 to 130 degrees. There was no evidence of loosening on the radiographs. Postoperative complications included fracture of the ulnar component in one patient, ulnar neurapraxia in three, and reflex sympathetic dystrophy in one. The results suggest that total elbow arthroplasty can be an alternative form of treatment of a severely comminuted fracture of the distal aspect of the humerus in older patients even in the presence of rheumatoid arthritis. This procedure is not an alternative to osteosynthesis in younger patients.
我们回顾性分析了连续20例（21个肘关节）肱骨远端急性骨折患者接受初次全肘关节置换术的结果。这些患者受伤时的平均年龄为72岁（范围48至92岁）。患者于1982年11月至1992年10月间接受治疗。9例（10个肘关节）患有类风湿关节炎的患者影响了治疗方案的选择。受伤至全肘关节置换术的平均间隔时间为7天（范围1至25天）。术后平均住院时间为7天（范围4至13天）。平均随访时间为3.3年（范围3个月至10.5年）。所有患者均至少随访2年或直至死亡；3例死亡患者的随访时间不足2年。无一例患者失访。在最近一次随访检查时，20个植入物完好无损。1例患者在初次手术后20个月因伸直手臂摔倒导致尺侧组件骨折，接受了翻修全肘关节置换术。根据梅奥肘关节功能评分，15个肘关节结果为优，5个为良；1个肘关节数据不足。没有结果为中或差的情况。平均屈曲弧度为25至130度。X线片上没有松动迹象。术后并发症包括1例尺侧组件骨折、3例尺神经失用和1例反射性交感神经营养不良。结果表明，即使存在类风湿关节炎，全肘关节置换术也可作为老年患者肱骨远端严重粉碎性骨折的一种替代治疗方式。对于年轻患者，该手术不能替代骨固定术。
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