兔肘关节尺侧副韧带急性损伤手术与非手术治疗后生物力学中位移和应变率的比较

[目的]比较兔急性肘关节尺侧副韧带损伤后手术修复与非手术治疗的差异.[方法]选取新西兰兔81只,随机分为3组,27只暴露出右尺侧副韧带后,但不切断,作为正常对照组(A);27只为切断右肘尺侧副韧带后随即缝合韧带,称为韧带缝合组(B);27只切断尺侧副韧带后不缝合,称为韧带不缝合组(C).分别在术后3、6、12周三个阶段取材,进行生物力学检测.[结果]术后12周,韧带缝合组断裂时的位移与不缝合组比较,差别有统计学意义[B(6.06±0.44)mm,C(7.72±0.44) mm,P<0.05];缝合组位移接近正常组,差别无统计学意义[A(5.87±0.46)mm,P>0.05];韧带缝合组应变率与不缝合组比较,差别有统计学意义[B(1.25±0.16),C(1.60±0.07),P<0.05],亦与正常组相近[A(1.19±0.13),P>0.05].[结论]肘关节尺侧副韧带急性损伤后手术治疗明显优于非手术治疗.     

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。     

手术与非手术治疗急性肘关节尺侧副韧带损伤的组织学及生物力学研究

目的 探讨手术修复与不修复急性肘关节尺侧副韧带损伤后韧带愈合的组织学及生物力学特性。方法 新西兰白兔56只，随机分为两组，其中28只切断右肘尺侧副韧带后随即缝合，为缝合组；另28只切断尺侧副韧带后不缝合，为不缝合组。分别于术后3、6、9、12周四个阶段取材，进行组织学观察及生物力学检测。结果12周时缝合组和不缝合组的韧带断端间均被平行的胶原纤维桥接，并与原韧带纤维相连，但前者翻转交错明显，纤维间隙较后者小。除术后3周外各时间点检测韧带缝合组位移均明显小于切断不缝合组，差异有统计学意义（P〈0．05），而最大负荷及功耗则明显高于韧带不缝合组，差异有统计学意义（P〈0．05）。结论 肘关节尺侧副韧带损伤后手术和非手术修复韧带均能愈合，但手术修复后的韧带愈合质量明显比未修复高。     

侧副韧带和跖板对跖趾关节屈曲功能的影响

目的探讨侧副韧带、跖板对跖趾关节屈曲功能的影响. 方法取成人尸体第2～4足趾,共24趾.按切断双侧侧副韧带和跖板的不同顺序均分为A、B两组(n=12),A组先切断双侧侧副韧带,再切断跖板薄弱部分,B组按相反顺序切断,观察不同顺序切断前后相同负荷下跖趾关节屈曲角度的变化.并于1994年5月～2000年7月,应用第2足趾游离跖趾关节复合组织移植重建第2和第3掌指关节11例,其中2例行跖板切除术,另9例行跖板 双侧侧副韧带切除术. 结果 A组,术前跖趾关节屈曲角度为37.30±5.42°,切断双侧侧副韧带后屈曲角度增加11.29±2.36°,达48.60±2.98°,与切断前比较差异有统计学意义(P<0.01);再次切断跖板后,屈曲角度增加5.30±1.59°,达53.35±2.76°,与切断前比较差异有统计学意义(P<0.01).B组,术前跖趾关节屈曲角度为34.59±5.32°,切断跖板后屈曲角度增加6.29±2.98°,达40.89±2.36°,与切断前比较差异有统计学意义(P<0.01);再次切断双侧侧副韧带后,屈曲角度增加9.71±1.94°,达50.60±2.01°,与切断前比较差异有统计学意义(P<0.01).切断双侧侧副韧带与切断跖板比较,前者更能增加跖趾关节的屈曲角度(P<0.01),二者切断的先后顺序对总屈曲角度改变影响无统计学意义(P>0.05).临床应用后随访显示,仅切断跖板者经2个月随访,屈曲角度为15～45°;切断跖板 双侧侧副韧带者经26.3个月随访,屈曲角度为10.3～58.4°. 结论切断双侧侧副韧带及跖板可增加跖趾关节屈曲角度.     

锁定钢板辅助肩袖缝合固定对老年性肱骨近端骨折的疗效探讨

[目的]通过测量肱骨头高度丢失及Neer评分比较,探讨肱骨近端内侧支撑重建和辅助肩袖缝合固定在锁定板治疗老年性肱骨近端骨折中的重要作用。[方法]回顾性分析2008年7月~2013年11月采用锁定板治疗的55例老年性肱骨近端骨折患者临床资料。根据是否辅助肩袖缝合固定及有无肱骨近端内侧支撑分为4组。A组:无肩袖缝合固定且无肱骨近端内侧支撑;B组:无肩袖缝合固定,但有肱骨近端内侧支撑;C组:有肩袖缝合固定,但无肱骨近端内侧支撑;D组:有肩袖缝合固定且有肱骨近端内侧支撑。测量随访时肱骨头高度丢失及评价术后肩关节功能,分析肱骨近端内侧支撑重建和肩袖缝合固定在骨折术后复位维持及功能恢复中的作用。[结果]55例患者随访13~33个月,平均17个月。A组7例,B组12例,C组15例,D组21例。术后3个月A组肱骨头高度丢失为(5.94±2.46)mm,明显高于B组(2.42±0.77)mm、C组(2.43±0.82)mm和D组(1.60±0.66)mm,差异有统计学意义(P0.05);B、C组相比差异无统计学意义(P0.05),但B、C组术后3个月肱骨头高度丢失明显高于D组(P0.05)。术后3~12个月A组肱骨头高度丢失(2.27±1.31)mm高于B组(0.52±0.40)mm、C组(0.53±0.29)mm、D组(0.50±0.31)mm,差异有统计学意义(P0.05),B、C、D组组间差异无统计学意义(P0.05)。末次随访时B、C、D组Neer评分优于A组,D组优于B、C组,差异有统计学意义,B、C组间差异无统计学意义。[结论]肱骨近端内侧支撑重建和肩袖缝合固定对于维持肱骨近端骨折术后复位有着重要作用,两者结合锁定板固定对于老年性肱骨近端骨折疗效满意。     

不同入路微型空芯螺钉内固定术治疗桡骨头骨折的疗效对照研究

目的探讨不同入路行微型空心螺钉内固定术治疗桡骨头骨折的临床疗效。方法桡骨头骨折病人67例,均行微型空芯螺钉内固定术,将67例病人分为两组,A组34例,经肘前侧入路;B组33例,经肘外侧入路。比较两组病人肘关节功能恢复情况、手术时间、并发症等。结果A组的手术时间[(37.2±3.4)min]、肘关节功能恢复时间[(245.2±31.2)d]均短于B组[(42.5±2.8)min,(245.2±31.2)d],骨折显露时间[(20.8±2.7)min]明显长于B组[(11.5±1.3)min],两组比较差异有统计学意义(P0.05)。两组骨折愈合时间[(10.2±2.1)m比(10.6±1.7)m]比较差异无统计学意义(P0.05)。A组术后半年肘关节屈伸弧、前臂旋前、前臂旋后活动度均高于B组,手术治疗优良率(85.29%比69.70%)高于B组,术后并发症发生率低于B组(P0.05)。结论与肘外侧入路比较,经肘前侧入路行微型空芯螺钉内固定术治疗桡骨头骨折的手术时间更短,对周围组织的损伤更轻,术后肘关节功能恢复更好。     

单纯寰椎侧块螺钉固定选择性治疗不稳定寰椎骨折的生物力学分析

【摘要】 目的：测试单纯寰椎侧块螺钉固定治疗不稳定寰椎骨折的生物力学稳定性,为临床应用提供理论依据。方法：取新鲜成人的完整枕骨及颈椎（C0-C3）标本6具,聚甲基丙烯酸甲酯包埋,在电子生物力学试验机上分别测定完整标本（A组）,寰椎骨折合并横韧带离断+寰椎侧块螺钉固定（B组）,横韧带、纵向韧带离断+寰椎侧块螺钉固定（C组）的前屈/后伸、左/右侧屈的运动变化以及前屈时C1-2的相对位移ADI（atlantodental interval）值,进行统计学分析,评价单纯寰椎侧块螺钉固定治疗不稳定寰椎骨折的生物力学稳定性,分析上颈椎韧带复合体的生物力学作用。结果：寰椎横韧带切断内固定后,载荷为50~90N时,A组与B组的ADI值、前屈、后伸相比,无统计学差异（P＞0.05）;当载荷为100N时,B组ADI值2.76mm、前屈11.66°、后伸14.05°,载荷为150N时,B组ADI值3.15mm、前屈15.27°、后伸16.25°,与A组相比均有统计学差异（P＜0.05）。横韧带切断后,载荷小于100N时,B组左、右侧屈与A组比较差异均无统计学意义（P＞0.05）;载荷100N时,B组左侧屈7.51°,与A组比较差异无统计学意义（P＞0.05）,B组右侧屈8.43°,与A组相比存在统计学差异（P＜0.05）;载荷150N时,B组左侧屈8.79°、右侧屈10.67°,与A组比较均有统计学差异（P＜0.05）。进一步切断纵向韧带,稳定性明显丧失,C组的ADI值和前屈、后伸、左右侧屈范围与A组相比均有显著统计学差异（P＜0.05）。结论：单纯寰椎侧块螺钉固定治疗寰椎骨折,恢复C0-2之间的高度,即恢复纵向韧带的张力能够维持生理载荷下寰枢椎的稳定性。     

复合腱-骨固定的生物力学及形态学研究

[目的]探讨不同固定方式对前交叉韧带重建中股骨隧道内移植物的影响。[方法]成年猪膝关节64个,以足部肌腱为移植物模拟前交叉韧带重建股骨侧腱-骨固定,固定方式随机分为5组,分别采用7 mm×23 mm界面螺钉固定(A组)、6 mm×23 mm界面螺钉固定(B组)、聚酯缝线4孔微钢板股骨外口固定(C组)、Endobutton固定(D组)和B与C固定组合(E组),进行生物力学测试并观察股骨隧道内口移植腱横截面积及厚度。[结果]持续施加200 N的轴向牵拉力条件下,A、B、E组轴向位移均为0 mm,C组的轴向位移为(5.51±0.53)mm,D组的为(5.49±0.51)mm;C组和E组移植物轴向位移差异有统计学意义(P<0.05)。最大损毁强度A组为(350.62±17.81)N,B组为(260.71±18.44)N,C组为(650.50±24.34)N,D组为(565.66±21.63)N,E组为(800.53±30.21)N,组间比较差异有统计学意义(F=291.352,P<0.01)。移植物内口横截面形态,A组的横截面呈"新月状",足印处移植物最大宽度为1 mm,横截面积为(10.06±0.18)mm~2;B组呈近似"满月状",足印处宽度为8 mm,面积为(38.16±0.32)mm~2;C组呈"满月状",足印处宽度为8 mm,面积为(40.02±0.21)mm~2;E组呈近似"满月状",足印处厚度为8 mm,面积为(38.86±0.29)mm~2。A、E组间比较差异有统计学意义(F=290.568,P<0.01)。此外,A组的挤压程度较重,B组较轻,C组的无挤压,E组同B组。[结论]复合固定技术不仅提供了足够的移植物初始固定强度,还有效避免了"雨刷和蹦极效应",减少了螺钉对肌腱的挤压切割,有利于移植物骨愈合和足印重建。     

局部单次使用bFGF及5-氟尿嘧啶促进屈肌腱愈合和防止粘连形成的实验研究

目的探讨局部单次使用bFGF及5-氟尿嘧啶(5-fluorouracil,5-FU)促进屈肌腱愈合和防止粘连形成的效果。方法成年雄性来亨鸡90只,体重3.0～3.5 kg,随机分为3组,每组30只。显露实验动物右爪第3趾趾深屈肌腱,A组切断肌腱后在断端使用纤维蛋白封闭剂(fibrin sealant,FS)0.6μL,原位缝合修复横断肌腱;B组肌腱断端使用bFGF和FS混合物0.6μL(内含bFGF 500 ng),原位缝合修复横断肌腱;C组在肌腱切断前先用5-FU浸泡肌腱,其余处理同B组。术后观察实验动物一般情况,于1、2、4、8周每组各取6只鸡第3趾行大体及组织学观察,术后8周每组另取6只鸡第3趾行生物力学测定。结果术后实验动物全部存活至实验完成,无肌腱断裂发生。术后8周,A组肌腱粘连程度与B、C组比较,差异均无统计学意义(P>0.05);C组粘连程度较B组轻(P<0.05)。组织学观察示,术后1、2、4周A组腱鞘、腱外膜及腱实质的成纤维细胞数均较B组少(P<0.05);C组在腱鞘、腱外膜少于A、B组(P<0.05),而在腱实质比A组多(P<0.05),与B组比较差异无统计学意义(P>0.05)。术后8周,各组间成纤维细胞数比较差异均无统计学意义(P>0.05)。术后4、8周A组腱鞘、腱外膜及腱实质的胶原纤维含量均少于B组(P<0.05)。在腱鞘、腱外膜,术后4周A组多于C组(P<0.05),术后8周两组间差异无统计学意义(P>0.05);在腱实质,各时间点A组均少于C组(P<0.05)。各时间点B组在腱鞘、腱外膜的胶原纤维含量均多于C组(P<0.05),而在腱实质两组间差异无统计学意义(P>0.05)。生物力学测定:A、B、C组肌腱滑动距离分别为(3.51±0.56)、(2.84±0.42)、(4.56±0.59)mm,屈曲功分别为(14.08±1.85)、(20.62±3.52)、(10.91±1.53)N.mm,最大抗拉力分别为(11.26±1.83)、(15.02±2.20)、(14.4±1.57)N。各组肌腱滑动距离和屈曲功比较,差异均有统计学意义(P<0.05);B、C组间最大抗拉力差异无统计学意义(P>0.05),但均大于A组(P<0.05)。结论 局部单次使用bFGF及5-FU在有效促进鸡屈肌腱愈合的同时能减轻肌腱粘连。     

5-氟尿嘧啶防治肌腱粘连的实验研究

目的研究局部应用5-氟尿嘧啶(5-fluorouracil,5-FU)对损伤肌腱修复术后肌腱粘连和愈合的影响。方法选用32只Leghorn鸡,4月龄,体重1.5～1.7kg。随机分为A、B组(n=16)。将第、、趾趾深屈肌腱切断以6-0尼龙线作改良Kessler法腱内缝合,8-0缝线作肌腱周边单纯连续缝合,A组用25mg/ml5-FU浸泡的脑棉(大小为7mm×20mm×1mm)贴合于肌腱修复部位腱鞘4次,每次1min;B组为对照,局部用生理盐水,方法同A组。分别于术后3、6周进行大体和组织学观察、透射电镜检查及生物力学检测。结果术后3、6周大体和组织学观察见A组粘连明显减少,术后6周A组肌腱愈合优良率为71.4%,B组肌腱愈合优良率为42.8%,A组高于B组,差异有统计意义(P<0.05)。3、6周肌腱滑动距离、康复顺应性A组分别为4.85±1.31mm、0.67±0.42mm与5.74±1.61mm、1.55±0.35mm,B组分别为2.99±0.51mm,0.24±0.14mm与3.65±0.54mm、1.22±0.16mm,A组与B组比较,差异有统计学意义(P<0.05);术后3周抗张力强度,A组20.28±4.92N,B组21.29±4.88N,差异无统计学意义(P>0.05);术后6周抗张力强度,A组47.12±6.76N,B组39.31±7.20N,A组与B组比较,差异有统计学意义(P<0.05)。结论5-FU可有效地减少肌腱粘连,无明显抑制肌腱的内源性愈合机制,是一种防治肌腱粘连理想的治疗措施。     

The in vivo isometric point of the lateral ligament of the elbow

BACKGROUND: Many reports have discussed reconstruction of the lateral ulnar collateral ligament for the treatment of posterolateral rotatory instability of the elbow, but information regarding the isometric point of the lateral ligament of the elbow is limited. The purposes of the present study were to investigate the in vivo and three-dimensional length changes of the lateral ulnar collateral ligament and the radial collateral ligament during elbow flexion in order to clarify the role of these ligaments as well as to identify the isometric point for the reconstructed lateral ulnar collateral ligament on the humerus where the grafted tendon should be anchored. METHODS: We studied in vivo and three-dimensional kinematics of the normal elbow joint with use of a markerless bone-registration technique. Magnetic resonance images of the right elbows of seven healthy volunteers were acquired in six positions between 0 degrees and 135 degrees of flexion. We created three-dimensional models of the elbow bones, the lateral ulnar collateral ligament, and the radial collateral ligament. The ligament models were based on the shortest calculated paths between each origin and insertion in three-dimensional space with the bone as obstacles. We calculated two types of three-dimensional distances for the ligament paths with each flexion position: (1) between the center of the capitellum and the distal insertions of the ligaments (to investigate the physiological change in ligament length) and (2) between eight different humeral origins and the one typical insertion of the lateral ulnar collateral ligament (to identify the isometric point of the reconstructed lateral ulnar collateral ligament). RESULTS: The three-dimensional distance for the lateral ulnar collateral ligament was found to increase during elbow flexion, whereas that for the radial collateral ligament changed little. The path of the lateral ulnar collateral ligament gradually developed a detour because of the osseous protrusion of the lateral condyle with flexion. The most isometric point for the reconstructed lateral ulnar collateral ligament was calculated to be at a point 2 mm proximal to the center of the capitellum. CONCLUSIONS: The radial collateral ligament is essentially isometric, but the lateral ulnar collateral ligament is not. The lateral ulnar collateral ligament is loose in elbow extension and becomes tight with elbow flexion.     

Lateral collateral ligament deficiency of the elbow joint: A modeling approach

A computational model capable of predicting the effects of lateral collateral ligament deficiency of the elbow joint would be a valuable tool for surgical planning and prediction of the long‐term consequences of ligament deficiency. The purpose of this study was to simulate lateral collateral ligament deficiency during passive flexion using a computational multibody elbow joint model and investigate the effects of ligament insufficiency on the kinematics, ligament loads, and articular contact characteristics (area, pressure). The elbow was placed initially at approximately 20° of flexion and a 345 mm vertical downward motion profile was applied over 40 s to the humerus head. The vertical displacement induced flexion from the initial position to a maximum flexion angle of 135°. The study included simulations for intact, radial collateral ligament deficient, lateral ulnar collateral ligament deficient, and combined radial and lateral ulnar collateral ligament deficient elbow. For each condition, relative bone kinematics, contact pressure, contact area, and intact ligament forces were predicted. Intact and isolated radial collateral ligament deficient elbow simulations were almost identical for all observed outcomes. Minor differences in kinematics, contact area and pressure were observed for the isolated lateral ulnar collateral ligament deficient elbow compared to the intact elbow, but no elbow dislocation was detected. However, sectioning both ligaments together induced substantial differences in kinematics, contact area, and contact pressure, and caused complete dislocation of the elbow joint. © 2016 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 34:1645–1655, 2016.     

桡骨小头切除晚期并发症的原因及机制探讨

目的：研究桡骨小头切除后晚期并发症产生的原因、发病机制和预防措施。方法：对２８例桡骨小头切除术后进行２年以上随访。同时对２０例新鲜上肢标本进行生物力学检测。结果：发现桡骨小头切除术后的晚期并发症有肘外翻畸形、创伤性关节炎、桡尺远侧关节脱位等。肘关节内侧副韧带损伤、骨间膜撕裂伤和桡尺关节远侧脱位是桡骨小头切除术后引起或加重晚期并发症的主要原因。结论：桡骨小头切除时,应考虑上述三种组织损伤是否存在及对预后的影响;桡骨小头切除在青少年患者应视为禁忌     

Ultrasonographic assessment of the ulnar collateral ligament and medial elbow laxity in college baseball players

BACKGROUND: The prevalence of medial elbow instability is high in athletes who throw, such as baseball players. The aim of this study was to assess the medial aspect of the elbow with ultrasonography to detect changes in baseball players. METHODS: Ultrasonography of the medial aspect of the elbow was performed, while gravity stress was applied with the elbow in 90 degrees of flexion, on thirty college baseball players (twelve pitchers and eighteen fielders) to assess medial joint laxity and deformity of the ulnar collateral ligament. The dominant (throwing) extremity was compared with the contralateral extremity. Clinical data were correlated with ultrasonographic findings. RESULTS: The medial joint space was significantly wider on the throwing side than it was on the contralateral side (2.7 mm and 1.6 mm, respectively; p < 0.01), and the proximal part of the ulna was shifted significantly laterally on the throwing side (p < 0.01). Angular deformity of the ulnar collateral ligament was found in five subjects, and it was significantly associated with lateral shift of the proximal part of the ulna (p < 0.01). Medial elbow pain was associated with widening of the medial joint space (p < 0.05) and with the presence of angulation of the ulnar collateral ligament (p < 0.01). CONCLUSIONS: Medial elbow laxity and elbow valgus on the throwing side of baseball players were increased compared with those in nonplayers. Angular deformity of the ulnar collateral ligament suggests that the ligament bends over the distal-medial edge of the trochlea. Ultrasonography can provide useful information about the condition of the ulnar collateral ligament and about medial elbow laxity in athletes who throw.     

Biomechanical study of ligaments around the elbow joint

The ligamentous contribution to elbow joint stability is a product of morphology and biologic parameters of each of the collateral ligaments. Better understanding of these characteristics is of paramount importance for successful ligament reconstruction in the surgery for joint replacement and traumatic injury. Two experiments were performed. In the first, the arc of elbow flexion where the individual ligament was either taut or slack was measured; in the second, the structural properties of each collateral ligament were determined by using bone-ligament-bone preparations. The anterior medial collateral ligament (AMCL) and radial collateral ligament (RCL) were taut throughout most of the entire arc of flexion. The posterior medial collateral ligament (PMCL) was taut only when the elbow was in a flexed position. Among the collateral ligaments, the AMCL was the strongest and stiffest with an average failure load of 260 N. The palmaris longus tendon, the most frequently used graft for elbow ligament reconstruction, was similar in strength (357 N).     

Single-strand reconstruction of the lateral ulnar collateral ligament restores varus and posterolateral rotatory stability of the elbow

Because of a lack of biomechanical studies of lateral elbow ligament reconstruction in the literature, the initial stability afforded by 3 different techniques of lateral ulnar collateral ligament reconstruction was evaluated in 8 cadaveric elbows. The arm was mounted in a testing apparatus, and passive flexion was performed with the arm in varus and valgus orientations. A pivot shift test was performed with the arm in the vertical orientation. An electromagnetic tracking device was used to quantify motion pathways. After intact testing, each specimen underwent sectioning of the radial collateral and lateral ulnar collateral ligaments from the lateral epicondyle. Reconstruction of the lateral ulnar collateral ligament was performed in a randomized sequence, consisting of proximal single-strand, distal single-strand, and double-strand tendon grafts. Division of the radial collateral and lateral ulnar collateral ligaments from the lateral epicondyle caused a significant decrease in rotational stability when the pivot shift test was being performed (P <.0001). Varus-valgus stability also decreased after transection of the radial collateral and lateral ulnar collateral ligaments (P <.0001). Reconstruction of the lateral ulnar collateral ligament restored elbow stability to that of the intact state. There was no significant difference in stability between the single- and double-strand repair techniques (P >.05). This study demonstrates that both single- and double-strand reconstructions restore varus and posterolateral elbow stability and may be considered appropriate reconstructive procedures in patients with symptomatic insufficiency of the lateral ligaments of the elbow.     

腕尺桡偏运动时腕韧带长度变化的活体研究

目的 研究腕关节在尺桡偏运动过程中,腕关节韧带长度的变化.方法 对6名志愿者腕关节进行CT扫描,获得腕关节在桡偏20°至尺偏40°内每隔20°的运动范围内各腕骨及尺桡骨远段三维重建图像.男3名,女3名,仅研究单侧右侧腕关节.年龄20～32岁,平均24岁.在腕关节尺桡偏运动过程中,在重建各腕骨及尺桡骨结构图像上以软件测量掌、背侧腕韧带的长度.结果 腕关节尺偏时桡舟头韧带、长桡月韧带、背侧腕间韧带止于舟骨、大多角骨和小多角骨部分的长度较中立位显著伸长,分别伸长(2.4±0.3)mm、(2.3±0.8)mm、(1.2±0.6)mm、(1.2±1.2)mm与(2.6±1.0)mm,差异均有统计学意义(P＜0.05);腕关节桡偏时尺头韧带与背侧桡腕韧带长度显著伸长(P＜0.05),分别为(0.8±0.6)mm和(1.0±0.5)mm.结论 在腕关节尺桡偏运动时,桡舟头韧带、长桡月韧带、背侧腕间韧带于桡偏位缩短,尺头韧带、背侧桡腕韧带长度于尺偏位缩短.这些位置可能使不同腕韧带张力降低,有利于损伤韧带的修复.     

超声结合应力实验在肘关节侧副韧带损伤中的临床意义分析

目的探讨在肘关节韧带损伤治疗中,应用超声检查判断肘关节稳定性的可靠性和临床意义。 方法选自2014年1月至2017年12月复旦大学附属华山医院收治的23例肘关节损伤病例,其中男11例、女12例,年龄15 ~ 68岁,平均年龄41.5岁。根据超声检查侧副韧带完整性作为依据,将术中应力实验结果作为治疗参考标准,以此决定肘关节韧带损伤的治疗方式。手术均采用韧带探查锚钉固定重建缝合术。随访肘关节功能评分和骨折愈合情况。 结果超声检查中发现14例患者内、外侧副韧带均撕裂;8例患者为外侧副韧带损伤,其中5例完全撕裂;1例患者为内侧副韧带损伤。以麻醉下应力实验结果作为金标准,其敏感性为97%,特异性为70%。采用Mayo肘关节功能评分系统,结果为优17例、良3例、中3例,优良率为87%。 结论对于肘关节侧副韧带损伤后稳定性的判断,超声检查是一项价廉、高效的检查方式,也有助于临床医生在术中结合应力实验结果对肘关节侧副韧带损伤处理作出判断。     

Ligamentous stabilizers against posterolateral rotatory instability of the elbow.

BACKGROUND: The lateral ulnar collateral ligament, the entire lateral collateral ligament complex, and the overlying extensor muscles have all been suggested as key stabilizers against posterolateral rotatory instability of the elbow. The purpose of this investigation was to determine whether either an intact radial collateral ligament alone or an intact lateral ulnar collateral ligament alone is sufficient to prevent posterolateral rotatory instability when the annular ligament is intact. METHODS: Sequential sectioning of the radial collateral and lateral ulnar collateral ligaments was performed in twelve fresh-frozen cadaveric upper extremities. At each stage of the sectioning protocol, a pivot shift test was performed with the arm in a vertical position. Passive elbow flexion was performed with the forearm maintained in either pronation or supination and the arm in the varus and valgus gravity-loaded orientations. An electromagnetic tracking device was used to quantify the internal-external rotation and varus-valgus angulation of the ulna with respect to the humerus. RESULTS: Compared with the intact elbow, no differences in the magnitude of internal-external rotation or maximum varus-valgus laxity of the ulna were detected with only the radial collateral or lateral ulnar collateral ligament intact (p > 0.05). However, once the entire lateral collateral ligament was transected, significant increases in internal-external rotation (p = 0.0007) and maximum varus-valgus laxity (p < 0.0001) were measured. None of the pivot shift tests had a clinically positive result until the entire lateral collateral ligament was sectioned. CONCLUSIONS: This study suggests that, when the annular ligament is intact, either the radial collateral ligament or the lateral ulnar collateral ligament can be transected without inducing posterolateral rotatory instability of the elbow.