全肘关节置换术的临床应用及疗效分析  

Clinical application and effective analysis for total elbow arthroplasty

作　　者：尹庆伟[1] 张海彬[1] 高玉贵[1] 李雅男[1] 宋美娜[1] 李洪灵[1] 王立刚[1] 臧志海[1] 

机构地区：[1]天津市东丽医院骨科,300300

出　　处：《中华骨科杂志》2015年第3期253-260,共8页Chinese Journal of Orthopaedics

摘　　要：目的 探讨全肘关节置换术治疗老年肱骨远端粉碎性骨折和肘部类风湿关节炎的临床疗效.方法 自2006年4月至2012年6月,应用半限制型全肘关节置换术治疗老年肱骨远端粉碎性骨折9例、肘部类风湿关节炎4例.男3例,女10例;50岁1例,大于60岁12例.肱骨远端骨折AO分型C2型3例、C3型6例.其中8例一期行全肘关节置换,1例开放性骨折（Gustilo-Anderson Ⅰ型）二期行全肘关节置换.4例肘部类风湿关节炎患者平均病程7.8年,Mayo分期Ⅲ期1例、Ⅳ期2例、Ⅴ期1例.全部采用铰链式-半限制型假体,以骨水泥固定.结果 手术时间120～180 min,平均150 min;出血量250～550 ml,平均400 ml;住院时间16～55 d,平均30.2 d.全部病例获得随访,随访时间15～82个月,平均39.5个月.12例切口一期愈合,1例类风湿关节炎患者发生急性切口感染.切口感染病例病原学检查为阴沟杆菌,经二期手术清理、置管冲洗引流4周,应用敏感抗生素治疗后痊愈.该例术中截骨时发生肱骨外髁骨折,给予克氏针张力带固定,术后4个月骨性愈合.随访期间全部病例均未发生假体松动、脱位等并发症.X线片示假体位置良好,7例骨水泥界面出现透光区.Mayo肘关节功能评分优3例、良8例、可2例,优良率84.6％（11/13）.结论 全肘关节置换治疗肘部类风湿关节炎和老年肱骨远端粉碎性骨折有效,但必须严格掌握手术适应证和遵循手术操作技巧,治疗肘部类风湿关节炎时术中及术后并发症发生率较高.Objective To explore the clinical efficacy of total elbow arthroplasty for elderly comminuted fractures of the distal humerus and elbow rheumatoid arthritis,Methods Thirteen patients including 9 cases of distal humeral comminuted fracture and 4 cases of elbow rheumatic arthritis were retrospectively analyzed,and they were treated by semiconstrained prosthesis from April 2006 to June 2012.There were 3 males and 10 females,among them,1 case was 50 years old,and 12 cases were more than 60 years old.According to AO classification system,there were 3 cases of type C2,6 cases of type C3.Eight operations were done in one stage,and 1 case of open fracture （Gustilo-Anderson type Ⅰ） was treated in two-stage.4 cases elbow rheumatic arthritis had average duration for 7.8 years,and there were 1 patient with stage Ⅲ,2 patients with stage Ⅳ,and 1 case with stage Ⅴ,according to Mayo classification.They all used the hinge-semiconstrained prosthesis,and fixed by bone cement.Results Surgerytime was from 120 min to 180 min （150 min in average）.Total blood loss was from 250 ml to 550 ml （400 ml in average）.The days of hospitalization were 16 to 55 （30.2 days in averagc）.All cases were followed up for 15 to 82 months （39.5 months in average）.Operative incision of 12 cases were primary healing,1 case of elbow rheumatic arthritis got local acute infection,and microbiology examination for enterobacter cloacae.After second stage operation for debridement and continuous irrigation drainage for 4 weeks,combined with sensitive antibiotics,the wound was healed.Meanwhile,this case＇s humeral condyle fractures occurred when osteotomy intraoperative,and was fixed with Kirschner wire tension band,and the fracture had healed after 4 months.There were no complications such as prosthesis loosening and dislocation.The prosthesis positions were good in radiography.7 cases showed lucent lesions in bone-cement interface.The elbow functions were graded by the system of Mayo.3 cases were in excellent,8 cases were good,2 cases

关 键 词：老年人 肱骨骨折 关节炎 类风湿 关节成形术 置换 肘 

分 类 号：R687.4[医药卫生—骨科学]