【摘要】 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。更多还原

【Abstract】 Objective To analyse short-term clinical effect of total elbow arthroplasty in treatment of distal comminuted humeral fracture with serious osteoporosis in geratic patients.Methods From April 2006 to October 2007, five cases of distal comminuted humeral fractures were treated by total elbow arthroplasty with bone cement.Of them, there were 2 males and 3 females, aging 50-76 years old(mean 67.6 years old), including 4 cases of closed fracture and 1 case of open fracture(II type Gustilo-Anderson).All fractures were caused by tumbling.According to classification of AO, there were 2 cases of type C1, 2 cases of type C2 and 1 case of type C3.The Barnett index of osteoporosis was 0.40-0.45.The time from injury to operation was 4 to 18 days(mean 7.2 days).The rehabilitation exercise of function was done after 2 days of operation.Results The operative time was from 120 to 180 minutes(mean 150 minutes), the bleeding amount was from 150 to 250 mL(mean 200 mL).All incision achieved primary healing.No complication occurred.Five cases were followed up for 19 to 36 months(mean 24.5 months).The mean motion range of elbow joint include 141.6° for flection, 6.5° for extention, 10.2° for the degree of ectropion, 81.7° for revolve forward, and 73.8° for revolve behind respectively after 4 months of operation.The length discrepancy of upper limb was less than 1.5 cm, the muscle force for flexion and extention of f inger and wrist was normal.The X-ray f ilms showed that the position of artificial joint was satisfactory without prosthesis dislocation or loosening.According to Mayo elbow performance score, the excellent and good rate was 80%(excellent in 1 case, good in 3 cases, and fair in 1 case).Conclusion Total elbow arthroplasty with bone cement is an effective method in treatment of distal comminuted humeral fracture with serious osteoporosis obviously in the geratic patients, but indication and technique of operation should be mastered strictly.更多还原