肱骨远端关节内骨折手术治疗的长期随访结果
Surgical Treatment of Intra-Articular Fractures of the Distal Part of the Humerus.Functional Outcome After Twelve to Thirty Years
肱骨远端关节内骨折手术治疗的功能结局（术后12至30年）
Abstract
Background: The short-term results of open reduction and internal fixation of intra-articular distal humeral fractures are good to excellent in approximately 75% of patients, but the long-term results have been less well studied. This investigation addressed the long-term clinical and radiographic results of surgical treatment of intra-articular distal humeral fractures (AO Type C) as assessed with use of standardized outcome measures.
研究背景：对肱骨远端关节内骨折的病人行切开复位内固定术，大约75%的病人近期结局是非常好的，但其远期结局缺乏足够的研究。本研究使用标准的结局评估方法阐明肱骨远端关节内骨折（AO分型为C型）手术治疗的远期临床及影像学结局。
Methods: Thirty patients were evaluated at an average of nineteen years (range, twelve to thirty years) after open reduction and internal fixation of a fracture of the distal part of the humerus to assess the range of elbow motion and the functional outcome. Twenty patients had an olecranon osteotomy, and all had fixation with plates and/or screws and/or Kirschner wires. No ulnar nerve was transposed.
方法：对30例肱骨远端关节内骨折后行切开复位内固定术的病人肘关节活动和功能结局进行评估。其术后平均时间为19年（从12至30年），其中有20例被行鹰嘴截骨，所有病人均以钢板、螺丝或Kirschner钢丝固定。
Results: Excluding one elbow salvaged with an arthrodesis and counted as a poor result, the average final flexion arc was 106° and the average pronation-supination arc was 165°. The average American Shoulder and Elbow Surgeons (ASES) score was 96 points, with an average satisfaction score of 8.8 points on a 0 to 10-point visual analog scale. The average Disabilities of the Arm, Shoulder and Hand (DASH) score was 7 points, and the average Mayo Elbow Performance Index (MEPI) score was 91 points. Including the patient with the arthrodesis, the final categorical ratings were nineteen excellent results, seven good results, one fair result, and three poor results. The presence of arthrosis did not appear to correlate with pain or predict disability or function. Subsequent procedures were performed in twelve patients (40%).
结果：排除一例行肘关节融合术而远期结局差的病人，平均肘关节弯曲度为106度，平均旋前、旋后度为165度。平均美国肩肘关节外科（ASES）记分为96分，其在0至10分视觉模拟评分上平均满意记分为8.8分。平均上肢、肩、手功能障碍（DASH）记分为7分，平均Mayo肘关节功能评估指数（MEIP）记分为91分。包括关节融合术的病例，在最终分类指标中19例结局很好，7例好，1例一般，3例差。未发生与疼痛及预期的功能障碍相关的关节病。12例行再次手术治疗（40%）。
Conclusions: The long-term results of open reduction and internal fixation of AO-Type-C fractures of the distal part of the humerus are similar to those reported in the short term, suggesting that the results are durable. Functional ratings and perceived disability were predicated more on pain than on functional impairment and did not correlate with radiographic signs of arthrosis.
结论：肱骨远端关节内骨折（AO分型为C型）行切开复位内固定术的远期结局与报道的近期结局相同，提示其结局具有持久性。功能指标及知觉障碍主要依靠疼痛而不是功能损害进行判定，与肘关节的影像学征象无关。
[ 本帖最后由 daike_ren 于 2008-7-1 12:53 编辑 ]
