CAJ | 학술논문

目的探讨全肘关节置换治疗老年患者肱骨远端骨折骨不连的临床效果。方法2005年2月至2010年11月，12例肱骨远端骨折骨不连患者行全肘关节置换手术。男5例，女7例，年龄(76±4)(69～83)岁。骨折类型(按照AO分型)：B型3例，C型9例。非手术治疗后肱骨远端骨折骨不连6例，切开复位内固定治疗失败6例。均采用美国Zimmer公司半限制型Coonrad-Morry人工肘关节假体进行关节置换。术后6个月进行MEPS评分( Mayo Elbow Performance Score )、肘关节活动范围检查和VAS评分等检查随访。结果12例均获(33.4±6.3)(25～45)个月随访。没有发生尺神经和血管损伤、肘关节脱位或关节不稳定、肱三头肌肌力弱、假体周围骨折、假体松动和断裂。MEPS评分由术前(29±13)(10～50)分上升到(85±10)( 65～100)分( P＜0.05)，其中优4例(33%)，良6例(50%)，可2例(17%)。肘关节活动范围从术前(18±11)(0～40)°提高到(108±21 )(75～135)° ( P＜0.05)；9例(75%)患者肘关节伸屈范围超过90°。患者肘关节疼痛明显缓解，VAS评分由(7.3±1.1 )(5～9)分下降至(1.3±0.9)( 0～2)分( P＜0.05)。结论全肘关节置换治疗老年患者肱骨远端骨折骨不连可以获得满意的临床效果。
목적탐토전주관절치환치료노년환자굉골원단골절골불련적림상효과。방법2005년2월지2010년11월，12례굉골원단골절골불련환자행전주관절치환수술。남5례，녀7례，년령(76±4)(69～83)세。골절류형(안조AO분형)：B형3례，C형9례。비수술치료후굉골원단골절골불련6례，절개복위내고정치료실패6례。균채용미국Zimmer공사반한제형Coonrad-Morry인공주관절가체진행관절치환。술후6개월진행MEPS평분( Mayo Elbow Performance Score )、주관절활동범위검사화VAS평분등검사수방。결과12례균획(33.4±6.3)(25～45)개월수방。몰유발생척신경화혈관손상、주관절탈위혹관절불은정、굉삼두기기력약、가체주위골절、가체송동화단렬。MEPS평분유술전(29±13)(10～50)분상승도(85±10)( 65～100)분( P＜0.05)，기중우4례(33%)，량6례(50%)，가2례(17%)。주관절활동범위종술전(18±11)(0～40)°제고도(108±21 )(75～135)° ( P＜0.05)；9례(75%)환자주관절신굴범위초과90°。환자주관절동통명현완해，VAS평분유(7.3±1.1 )(5～9)분하강지(1.3±0.9)( 0～2)분( P＜0.05)。결론전주관절치환치료노년환자굉골원단골절골불련가이획득만의적림상효과。
Objective To investigate the clinical outcomes of total elbow arthroplasty ( TEA ) for distal humeral nonunion in elderly patients. Methods From February 2005 to November 2010, 12 patients with distal humeral nonunion underwent TEA. There were 5 males and 7 females, whose average age was ( 76±4 ) years old ( range;69-83 years ). The fractures were formerly classiifed according to the AO classiifcation, including 3 cases of type B and 9 cases of type C. Distal humeral nonunion caused by the failure of non-surgical treatment occurred in 6 cases, and by the failure of open reduction and internal ifxation in the other 6 cases. The semi-constrained Coonrad-Morry artiifcial elbow joints ( Zimmer, Warsaw, IN, USA ) were used. The Mayo Elbow Performance Score ( MEPS ), Range of Motion ( ROM ) of the elbow joint and Visual Analogue Scale ( VAS ) were investigated at 6 months after the operation. Results All patients were followed up for an average period of ( 33.4±6.3 ) months ( range;25-45months ). No ulnar nerve or vascular injuries, dislocation or instability of the elbow joint, weakness of the triceps muscle, periprosthetic fractures or prosthesis loosening or breakage were found. The average MEPS was ( 29±13 ) points ( range;10-50 points ) preoperatively and ( 85±10 ) points ( range;65-100 points ) postoperatively ( P<0.05 ). The results were excellent in 4 cases ( 33%), good in 6 cases ( 50%) and fair in 2 cases ( 17%). The average ROM of the elbow joint was ( 18±11 ) degrees ( range;0-40 degrees ) preoperatively, which was increased to ( 108±21 ) degrees ( range;75-135 degrees ) postoperatively ( P<0.05 ). The lfexion and extension of ROM of the elbow joint was more than 90 degrees in 9 patients ( 75%). The pain of the elbow joint in patients was obviously relieved. The VAS score was ( 7.3±1.1 ) points ( range;5-9 points ) preoperatively, which was reduced to ( 1.3±0.9 ) points ( range;0-2 points ) postoperatively ( P<0.05 ). Conclusions The clinical outcomes of TEA for distal humeral nonunion in elderly patients are satisfactory.