全肘关节置换术治疗复杂肱骨髁间骨折的早期临床疗效分析  

The preliminary treatment effect of the complex humeral intercondylar fractures with total elbow replacement

作　　者：姜保国[1] 张殿英[1] 付中国[1] 

机构地区：[1]北京大学人民医院创伤骨科,100044

出　　处：《中华骨科杂志》2007年第2期110-114,共5页Chinese Journal of Orthopaedics

基　　金：国家973计划资助（2005CB522604）;北京市科技重大项目（Z0005190041391）

摘　　要：目的探讨肘关节置换术治疗复杂肱骨髁间骨折的早期疗效。方法2005年8月至2006年4月，通过肘关节置换术治疗3例复杂肱骨髁间骨折患者。1例男性，38岁，伴血友病关节炎，AO分型为C2型骨折，行一期肘关节置换。2例女性，年龄分别为66、82岁，伴类风湿关节炎，其中1例AO分型为C1型，行一期肘关节置换；另1例AO分型为C2型，行切开复位内固定手术失败后接受肘关节置换术。以Mayo评分评估其肘关节功能。结果3例患者均获得随访，随访时间3～10个月。1例伴血友病关节炎的肱骨髁间骨折患者术后的Mayo评分为良（75分），2例伴类风湿关节炎的肱骨髁间骨折患者中，内固定手术失败后接受肘关节置换的患者Mayo评分为良（85分），另1例患者的Mayo评分为优（95分）。3例肘关节置换患者近期随访均未出现疼痛、假体松动或假体周围骨折等并发症。结论对年龄偏大、骨质疏松明显、骨折粉碎难以复位和固定、关节毁损严重的老年肱骨髁间骨折患者，实施肘关节置换术可获得满意疗效。Objective To discuss the treatment effect of complex humeral intercondylar fractures with total elbow replacement. Methods From August 2005 to April 2006, 3 cases of the complex humeral intercondylar fractures were treated with total elbow replacement, one case is male, 38 years old, associated with haemophilia arthritis, 2 cases are female, 66 and 82 years old respectively, associated with rheumatoid arthritis. The patient associated with haemophilia arthritis and the patient, 66 years old, associated with rheumatoid arthritis, accepted primary total elbow replacement, another patient, 82 years old, associated with rheumatoid arthritis, firstly accepted open reduction and internal fixation, after the operation failed, accepted total elbow replacement. All 3 cases were followed up for 3 to 10 months, and evaluated with Mayo elbow performance score. Results The patient associated with haemophilia arthritis rated as good （75 point）. Between 2 cases associated with rheumatoid arthritis, the patient whose open reduction and internal fixation failed rated as good （85 point）, the patient who accepted primary total elbow replacement rated as excellent （95 point）. No local pain or prothesis loosening occured among 3 cases. Conclusion To treat elderly cases of complex humeral intercondylar fractures, whose bone was obvious osteoporosis, the fracture so comminuted that it is difficult to be reduced and fixed, and the articular surface heavily damaged, the total elbow replacement method can attain satisfactory result.

关 键 词：肱骨骨折 肘关节 关节成形术 置换 

分 类 号：R686[医药卫生—骨科学]