认识桡骨近端19项解剖学指标对人工假体及肘关节生物力学重建的价值*★

背景：制约桡骨近端骨折治疗及内固定物、假体设计和改进的一个重要因素是该部位的解剖学形态。 目的：测量桡骨近端19项解剖学指标, 为桡骨近端骨折内固定物的合理放置及桡骨头正确切除、假体的设计和改进提供参考依据。 设计、时间及地点：重复测量，对比观察实验，于2007-12/2008-04在江苏省南通大学附属医院创伤研究室完成。 材料：成人30对防腐尸体上肢标本，男、女各15对。 方法：对上述标本解剖并取出尺桡骨，利用精度0.01 mm的游标卡尺、分规、量角器对桡骨近端数项解剖学指标进行测量。 主要观察指标：①桡骨近端相关角度：桡骨颈干角、桡骨头环状关节面和尺骨桡骨切迹在前臂中立位时接触弧、前臂最大旋前位时接触弧度、前臂最大旋后位时接触弧度、非接触弧度；②桡骨近端相关高度、长度、横径、矢状径等：桡骨近端长度、环状关节面内侧、外侧、前侧及后侧高度、桡骨头凹最大深度、桡骨近端外侧弧长度、外侧弧的最大垂直高度、桡骨转子上缘桡骨颈横径、桡骨转子上缘-桡骨头近端距离、桡骨转子中部-桡骨头近端距离、桡骨头横径、桡骨头矢状径、桡骨头凹直径。 结果：男、女在桡骨近端相关角度方面测量值的差异无统计学意义(P > 0.05)；而在桡骨近端相关高度、长度、横径、矢状径等方面男性测量值大于女性(P < 0.05) 。 结论：桡骨近端骨折在行内固定或桡骨头切除、假体置换时, 需遵循桡骨近端各项解剖参数；因男性桡骨近端的解剖参数略大于女性，设计时应根据不同性别做成各种型号的假体。

Clinical significance of 19 anatomical parameters of the proximal end of the radius in prosthesis biomechanical reconstruction

BACKGROUND: The anatomical morphology of the proximal end of the radius is an important factor restricting the treatment of fracture, design and improvement of internal fixator and prosthesis. OBJECTIVE: To measure 19 anatomical parameters of the proximal end of the radius to provide references for reasonable placement of internal fixator, correct excision of radial head and improved design of prosthesis in treating radial proximal fractures. DESIGN, TIME AND SETTING: The repetitive measurement and contrast observation were performed at the Trauma Research Room, Hospital of Nantong University from December 2007 to April 2008. MATERIALS: Thirty pairs of upper limb samples from adult antisepsis corpses were randomly selected, including 15 pairs from males and 15 pairs from females. METHODS: These specimens were dissected to remove the radius and ulna. The anatomical parameters of the proximal end of the radius were measured with slide gaud (0.01 mm in precision), calipers and goniometer. MAIN OUTCOME MEASURES: Angles related to the proximal end of the radius: the axis of the radial neck and diaphysis, the range of contact of radians between the articular circumference and the ulnar and radial notch at the neutral position, the maximum range of pronation of the forearm, the maximum range of supination of the forearm, and the range of non-contact of radian; Results of height, length, transverse and sagittal diameters related to the proximal end of the radius: the length of the proximal end of the radius, the medial height of the articular circumference, the lateral height of the articular circumference, the anterior height of the articular circumference, the posterior height of the articular circumference, the maximum depth of the fovea of radial head, the length of the lateral arc of the proximal end of the radius, the maximum vertical height of the lateral arc, the transverse diameter of the radial neck above radial tuberosity, the distance between the proximal end of radial head and the superior border of radial tuberosity, the distance between the proximal end of radial head and the middle of radial tuberosity, the transverse diameter of radial head, the sagittal diameter of radial head, and the diameter of the fovea of radial head. RESULTS: There were no significant differences between males and females in terms of angles related to the proximal end of the radius (P > 0.05). The measurement results of height, length, transverse and sagittal diameters related to the proximal end of the radius in males were significantly larger than in females (P < 0.05). CONCLUSION: In the treatment of radial proximal fractures, the anatomical parameters of the proximal end of the radius should be considered in performing excision of radial head, internal fixation and prosthesis replacement. Because the parameters of males are larger than females, the prosthesis size should be changed.