肘关节后外侧旋转不稳定韧带损伤的载线影像学特点研究

目的 ：探讨肘关节外侧韧带复合体对肘关节后外侧旋转不稳定的作用及韧带损伤时肘关节侧位X线影像学中桡肱率变化特点。方法：取冷冻保存的新鲜成人肘关节标本20侧,将标本制成肘关节＂骨-韧带＂标本,随机分为两组。利用自行设计的维持肘关节后外侧旋转活动度的设备固定标本,A组按次序切断外侧结构：A1组,外侧韧带完整的标本组;A2组,切断桡侧尺副韧带组;A3组,增加切断环状韧带组;A4组,最后切断桡侧副韧带组。B组分为：B1组,外侧韧带完整的标本组;B2组,切断桡侧副韧带组;B3组,再切断环状韧带组;B4组,最后切断桡侧尺副韧带组。分别摄肘关节侧位X线片,在PACS系统中测量桡肱率,比较各组的差异,并统计分析。结果：A组,统计分析各组数据,各组间桡肱率增加差异有统计学意义。B组,统计分析前2次切断韧带,各组间桡肱率增加差异无统计学意义。切断桡侧尺副韧带（B4组）,与前3组比较差异有统计学意义。结论：桡侧尺副韧带是限制肘关节后外侧旋转脱位的主要结构,环状韧带、桡侧副韧带为次要结构;并根据肘关节后外侧旋转不稳定X线影像学特点将其分为4个等级。

X-ray characteristics of posterolateral rotatory instability of the elbow caused by ligament injury

Objective: To compare therapeutic effects of local injection with autoallergic platelet rich plasma (PRP) or autoallergic whole blood (AWB) for the treatment of chronic tennis elbow.Methods: From January 2011 to January 2014,40 patients with chronic tennis elbow were divided into 2 groups,20 cases in each group:PRP group and AWB group. There were 20 patients in PRP group treated with local injection of autoallergic platelet rich plasma,including 5 males and 15 females,with an average age of (47.50±9.86) years old;and the average course of disease was (4.67±3.27) months. Among the 20 patients in AWB group treated with local injection of autoallergic whole blood,3 patients were male and 17 patients were female,with an average age of(46.50±9.96) years old;and the average course of disease was (4.53±2.27) months. The elbow joint was fixed with elastic stockings after injection. All the patients were guided to do strengthening and extension exercises during the follow-up period. Visual analog scale(VAS),Mayo scores for elbow and pressure pain threshold (PPT) were used to evaluate clinical effects after injection immediately and 4,8 weeks after treatment.Results: All the patients were followed up,there were no infections and swelling occurred. The VAS,Mayo and PPT scores of patients in PRP group were improved from pre-therapy 7.22±1.32,56.71±10.90 and 17.47±4.62 to 2.73±1.00,91.59±6.95 and 21.35±4.80 respectively 8 weeks after treatment. The VAS,Mayo and PPT scores of patients in AWB group were improved from pre-therapy 7.16±1.27,54.72±8.36 and 17.06±4.83 to 3.81±1.36,82.06±7.89 and 20.12±4.97 respectively 8 weeks after treatment. All the pain and functional variables including VAS,PPT,and Mayo scores were improved significantly in both groups 4 weeks after injection. On the 4th week after injection,there was no statistically significant difference in PPT between two groups;while the VAS and Mayo score of AWB group were lower than those of PRP group. On the 8th week after injection,the VAS of AWB group was higher than that of PRP group;but the Mayo and PPT scores of AWB group were lower than those of PRP group.Conclusion: PRP and AWB injections are both effective to treat chronic lateral epicondylitis. Compared with AWB injection,PRP injection may be more effective in releasing pain and improving function for a longer time.