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目的探讨人工全肘关节置换术治疗伴严重骨质疏松的肱骨远端粉碎性骨折的近期临床疗效。方法2006年4月-2007年10月,采用骨水泥半限制型假体对5例伴严重骨质疏松的肱骨远端粉碎性骨折患者行人工全肘关节置换。男2例,女3例;年龄50～76岁。均为摔伤。闭合骨折4例;开放骨折1例,Gustilo分型为Ⅱ型。骨折根据AO分型:C1型2例,C2型2例,C3型1例。骨质疏松Barnett指数为0.40～0.45。伤后至手术时间4～18d,平均7.2d。术后第2天开始康复锻炼。结果手术时间120～180min,平均150min;出血量150～250mL,平均200mL。术后切口均Ⅰ期愈合,术后早期无相关并发症发生。5例术后均获随访,随访时间19～36个月,平均24.5个月。术后4个月肘关节屈曲平均141.6°,伸直平均6.5°,外展角平均10.2°;旋前平均81.7°,旋后平均73.8°。双上肢长度相差<1.5cm,手指与腕关节屈曲及背伸肌力正常。X线片示假体位置良好,无松动、脱位。根据Mayo肘关节功能评分标准:优1例,良3例,中1例,优良率为80%。结论人工全肘关节置换是治疗伴严重骨质疏松肱骨远端粉碎性骨折的有效方法之一,但必须严格掌握手术适应证和术中操作技巧。
Objective To investigate the short-term clinical efficacy of artificial total elbow joint replacement in the treatment of comminuted distal humeral fractures with severe osteoporosis. Methods From April 2006 to October 2007, artificial elbow replacement was performed in 5 patients with comminuted distal humeral fractures with severe osteoporosis by using the semi-restrictive implants. 2 males and 3 females; aged 50 to 76 years old. All fall. Closed fracture in 4 cases; open fracture in 1 case, Gustilo type Ⅱ. Fracture according to AO classification: C1 in 2 cases, C2 in 2 cases, C3 in 1 case. Barnett index of osteoporosis is 0.40 ~ 0.45. Injury to operation time 4 ~ 18d, an average of 7.2d. 2 days after the start of rehabilitation exercise. Results The operation time was 120 ~ 180min with an average of 150min. The amount of bleeding was 150 ~ 250mL with an average of 200mL. Postoperative incision healed at first stage, no postoperative complications occurred in the early stage. All the 5 patients were followed up for 19-36 months with an average of 24.5 months. At 4 months after operation, flexion of the elbow joint averaged 141.6 ° with an average of 6.5 ° extension and an abduction angle of 10.2 °, an average of 81.7 ° before pronation and an average of 73.8 ° after supination. Differences in the length of the upper extremity <1.5cm, finger and wrist flexion and back extensor strength normal. X-ray showed prosthesis in good position, no loosening, dislocation. According to Mayo elbow joint function evaluation criteria: excellent in 1 case, good in 3 cases, 1 case, excellent and good rate was 80%. CONCLUSION: Artificial elbow replacement is one of the effective ways to treat comminuted distal humeral fractures with severe osteoporosis. However, surgical indications and intraoperative operative techniques must be strictly controlled.