Functional outcome following surgical treatment of intra-articular distal humeral fractures through a posterior approach
Functional outcome following surgical treatment of intra-articular distal humeral fractures through a posterior approach
复制标题
DOI：
10.2106/00004623-200012000-00003
复制
发表时间：
2000-12-01
影响因子：
5.3
通讯作者：
Richards, RR
中科院分区：
文献类型：
--
作者：
McKee, MD;Wilson, TL;Richards, RR
背景：虽然手术修复被认为是移位的肱骨远端关节内骨折的标准治疗方法，但大多数研究人员使用基于手术和/或基于x线片的结果测量来评估其结果。本研究的目的是确定移位肱骨远端关节内骨折固定的功能结果，采用标准化的评估方法，包括客观测试肌肉力量和使用基于患者的问卷（肢体特异性和一般健康状况问卷）。方法：我们确定了25例患者（男性14例，女性11例），平均年龄47岁，他们患有肱骨远端孤立、闭合、移位、髁间、关节内骨折，经后路手术修复，并在内侧柱和外侧柱上用钢板固定。所有患者返回进行随访，包括记录完整病史、体格检查、影像学检查、完成肢体特异性问卷（臂、肩和手残疾[DASH]）和一般健康状况问卷（SF-36 [SF-36]），以及客观肌肉力量测试。结果：平均随访时间为37个月（18 ~ 75个月），平均屈曲挛缩25度（5 ~ 65度），平均屈伸108度（55 ~ 140度）。与正常侧相比，在90度肘关节屈曲（正常的74%，p = 0.01）和45度肘关节伸直（正常的76%，p = 0.01）、90度肘关节伸直（正常的74%，p = 0.01）和120度肘关节伸直（正常的75%，p = 0.01）时，平均肌肉力量明显下降，平均DASH评分为20分，表明轻度残余损伤。SF-36得分显示角色-身体和身体功能得分有轻微但显著的下降（p分别为0.01和0.03），而心理成分和平均得分没有变化。6例患者（24%）再次手术；其中3例切除了用于固定鹰嘴截骨部位的突出硬件。结论肱骨远端关节内骨折的手术修复是一种有效的方法，可以可靠地维持患者基于问卷的总体健康状况。我们的研究量化了这些患者的活动范围和肌肉力量的减少，这可能有助于解释肢体特异性结局测量和总体健康状况测量的物理功能组成部分检测到的轻度残留物理损伤。
Background: While surgical repair is considered the standard of care of displaced intra-articular distal humeral fractures, most investigators have assessed its results with use of surgeon-based and/or radiograph-based outcome measures. The purpose of our study was to determine the functional outcome of fixation of displaced intra-articular distal humeral fractures with use of a standardized evaluation methodology consisting of objective testing of muscle strength and use of patient-based questionnaires (both limb-specific and general health-status questionnaires).Methods: We identified twenty-five patients (fourteen male and eleven female), with a mean age of forty-seven years, who had an isolated, closed, displaced, intercondylar, intra-articular fracture of the distal part of the humerus repaired operatively through a posterior approach and fixed with plates on both the medial and the lateral column. All patients returned for follow-up that included recording of a complete history, physical examination, radiographic examination, completion of both a limb-specific questionnaire (Disabilities of the Arm, Shoulder and Hand [DASH]) and a general health-status questionnaire (Short Form-36 [SF-36]), and objective muscle-strength testing.Results: The mean duration of follow-up was thirty-seven months (range, eighteen to seventy-five months), The mean flexion contracture was 25 degrees (range, 5 to 65 degrees), and the mean are of flexion-extension was 108 degrees (range, 55 to 140 degrees). Significant decreases in mean muscle strength compared with that on the normal side were seen in both elbow flexion measured at 90 degrees (74 percent of normal, p = 0.01) and elbow extension measured at 45 degrees (76 percent of normal, p = 0.01), 90 degrees (74 percent of normal, p = 0.01), and 120 degrees (75 percent of normal, p = 0.01), The mean DASH score was 20 points, indicating mild residual impairment, The SF-36 scores revealed minor but significant decreases in the role-physical and physical function scores (p = 0.01 and 0.03, respectively) but no alteration of the mental component or mean scores. Six patients (24 percent) had a reoperation; three of them had removal of prominent hardware used to fix the site of an olecranon osteotomy.Conclusions The surgical repair of an intra-articular distal humeral fracture is an effective procedure that reliably maintains general health status as measured by patient-based questionnaires, Our study quantified a decrease in the range of motion and muscle strength of these patients, which may help to explain the mild residual physical impairment detected by the limb-specific outcome measures and physical function components of the general health-status measures.