肘关节稳定性的应用解剖和生物力学研究

目的 :为临床认识和治疗急、慢性肘关节不稳定提供基础。方法 :解剖观察肘关节副韧带的形态结构特点 ,测量依序切断桡侧软组织 (包括桡侧副韧带 )时肘关节后外侧旋转度的变化、依序切断肘关节尺侧副韧带时其外翻旋转角度的变化。结果 :①尺侧副韧带前束可分为前部纤维和后部纤维 ;桡侧副韧带部分止于环状韧带 ,部分止于尺骨冠突的外下方。②屈曲 60°以前 ,尺侧副韧带前束的外侧部紧张而内侧部较松弛 ,肘关节屈曲超过 60°后 ,前束内外侧处于同等程度的紧张状态 ;后束在肘关节屈曲超过 90°后才被拉紧。③肘关节桡侧副韧带复合体对维持关节外侧的稳定作用约占 5 0 % ,伸肌及伸肌腱膜起协同作用。结论 :肘关节副韧带是维持肘关节稳定的重要结构 ,在肘关节的运动过程中 ,副韧带的不同组成部分发挥着不同的作用 ,其中桡侧尺副韧带和尺侧副韧带前束是肘关节主要的稳定结构     

改良肘关节内侧入路尺侧副韧带手术的应用解剖

目的：为肘关节经肌肉入路尺侧副韧带（ＵＣＬ）修复术提供解剖学基础。方法：成人肘关节标本３５侧,解剖观察尺侧副韧带前束、肘部屈肌总腱及尺、正中神经分支的解剖关系,并行摹拟手术。结果：ＵＣＬ前束起于肱骨内侧髁的前下方,止于尺骨冠突内侧的小结节,ＵＣＬ前束位于尺侧腕屈肌肱头、尺头之间的深层;尺神经在肘管中部与尺侧副韧带前束的平均距离为（０．９ ± ０． １）ｃｍ,在肘管的远侧出口,距尺侧副韧带的尺骨止点（０．６±０．３）ｃｍ;尺神经至尺侧腕屈肌尺头肌支的入肌点距肱骨内侧髁的距离为（３．７±０．８）ｃｍ;正中神经最靠近切口的分支距切口的距离,在肱骨内侧髁和尺骨结节水平分别为（１．６±０．５）ｃｍ和（０．９±０．４）ｃｍ。结论：经尺侧腕屈肌的肱头和尺头之间、自肱骨内侧髁向前外侧至ＵＣＬ尺骨止点以远约２ ｃｍ为一损伤较小的安全手术入路。     

肘关节后外侧旋转不稳定的解剖与生物力学研究

目的研究肘关节外侧软组织对维持肘关节后外侧旋转稳定的作用。方法通过解剖肘关节观察外侧软组织的形态结构特点;通过生物力学实验研究其序列切断时肘关节旋转度的变化。结果肘关节伸肌起始于防骨gF＃的肌健膜上,肌胞膜部分随肌肉走行成为肌间隔,部分止于尺骨鹰嘴外侧骨面;烧侧副韧带止于尺骨冠突的部分为侥侧尺副韧带,其与烧骨环状韧带在尺骨上的止点有2种类型：I型,榜顺IJ韧带的部分纤维汇入烧骨环状韧带的尺骨止点,另一部分纤维单独止于稍远的尺骨上;11型,按顺觑带与愧骨环状韧带形成一宽的纤维止于尺骨上。肘关节侥侧副韧带…     

肱肌止点的解剖学研究及其在钢板固定尺骨冠突骨折中的应用

目的测量肱肌止点的相关数据,为临床准确、安全地放置冠突钢板提供解剖学依据。方法 8例正常新鲜成人肘关节标本,解剖观察肱肌止点的位置,并测量肱肌止点的长度、宽度、与内侧副韧带前束附着的间隙宽度及近端距离冠突尖的长度。结果肱肌止点大部分位于尺骨鹰嘴尖与冠突尖连线的内侧,长度为(21.79±2.70)mm,分深浅两头:浅头止点为腱膜组织,宽度(4.11±1.12)mm;而深头止点由两侧的腱膜和中间的肌肉构成,宽度(11.25±3.07)mm。其中,桡侧腱膜宽度(1.77±0.46)mm,尺侧腱膜宽度(2.75±0.57)mm,两者夹持的肌肉宽度(6.82±2.08)mm。肱肌止点与内侧副韧带前束附着的间隙宽度(4.14±0.49)mm,近端距离冠突尖的长度(9.30±1.51)mm。结论 (1)肱肌止点与内侧副韧带前束附着的间隙可用于放置尺骨冠突钢板。(2)松解肱肌深头止点的尺侧腱膜可使该间隙的宽度达到6.89mm,继续松解中间的肌肉可达到13.71mm,足以安放冠突钢板。     

尺骨冠突软组织附着点的解剖学观测及其与冠突骨折类型的关系

目的：观测尺骨冠突软组织附着点的解剖参数,为了解冠突骨折的类型特征及其治疗方法提供解剖学依据.方法：解剖10侧成人肘关节标本（4侧新鲜、6侧防腐）,用游标卡尺和网栅描图法测量肘关节囊前部、内侧副韧带前束和肱肌附着点,距冠突尖、关节面的距离、止点长度和面积等.结果：肘关节囊前部附着在冠突尖远侧平均（5.7±2.4）mm,冠突尖是关节腔内结构.内侧副韧带前束附着在高耸结节处,距关节面平均（1.4±0.7）mm,长度平均（14.3±3.9）mm,附着面积平均（113.7±25.2）mm^2.肱肌附着在尺骨粗隆处,距冠突尖平均（9.3±1.5）mm,其长度平均（21.8±2.7）mm,附着面积平均（207.5±33.8）mm^2,由＂腱膜-肌肉-腱膜＂的＂三明治样＂结构组成.肱肌附着点和内侧副韧带前束附着点的间隙平均宽（4.1±0.5）mm,手术必须松解尺侧腱膜（间隙扩大至7 mm）甚至中间的肌肉（间隙扩大至14 mm）才能安放冠突钢板.结论：了解冠突的软组织附着参数,对临床理解冠突骨折的类型和选择正确的处理方法有重要价值.     

肘关节副韧带的MRI检查方法及影像特点

目的：研究肘关节有关结构的MRI检查方法和影像特点。方法：急性肘关节后脱位2例和慢性肘关节后脱位1例，行MRI检查。结果：冠状位MRI可清楚地显示肘关节诸结构，并可显示损伤的肝关节副韧带，矢状位部分层面可分别显示尺侧和桡侧副韧带，横断面不能完整地显示肘关节副韧带。副韧带损伤的常规MRI影像特点，在冠状位SE序列T2加权像，呈低信号，尺侧副韧带在尺骨冠突内侧呈薄止点，线型或稍呈弧形向近端，在肱骨骨侧髁止点稍扩散，其损伤的表现有韧带的增厚或变薄、韧带松驰及不连续包绕韧带的水肿或血肿的高信号影等。结论：肘关节副韧带的MRI检查是较准确、敏感、无损伤的方法，值得进行进一步探讨。     

尺骨冠突损伤的重建策略研究进展

尺骨冠突损伤多合并桡骨头、尺骨鹰嘴、肱骨远端、尺桡骨近端等肘关节其他部位骨折,常伴关节脱位以及肘关节内外侧副韧带或肘关节囊撕裂伤[1]。随着对肘关节解剖特点、生物力学、手术技巧以及材料应用的研究不断深入,人们逐步认识到尺骨冠突对于肘关节损伤患者关节稳定性的保持起着至关重要的作用,并就不同类型尺骨冠突骨折的治疗方案也逐步达成共识,且取得了较为满意的治疗效果。当骨折碎片过小,以至于无法修复冠突或修复后冠突功能不良等情况时,重     

肘关节副韧带复合体

肘关节副韧带复合体包括尺侧韧带复合体（ＭＣＬＣ）和桡侧韧带复合体（ＬＣＬＣ）,它们是维持肘关节稳定的重要结构,Ｏ’Ｄｒｉｓｃｏｌｌ［１］认为,维持肱尺关节的稳定须具备三个条件：完整的关节面,完整的ＭＣＬＣ前束和ＬＣＬＣ的尺副韧带。ＭＣＬＣ损伤将导致肘关节外翻不稳定,ＬＣＬＣ损伤则引起肘关节后外侧旋转不稳定。本文将从解剖、生物力学和临床等几个方面综述其研究进展。１　肘关节副韧带复合体的解剖ＭＣＬＣ是由前束、后束和斜束组成的。一般认为,尺侧副韧带的前束起始于肱骨内上髁之前,止于喙突内缘,后束起始于内…     

膝关节前交叉韧带后外束股骨止点位置的解剖

目的 通过对膝关节前交叉韧带后外束股骨止点的解剖测量,找到确定前交叉韧带后外束股骨止点的简单可行的方法,为双束重建前交叉韧带手术中的骨道定位提供理论依据。方法 解剖20例新鲜膝关节标本（25~45岁）。在屈膝90°位,测量前交叉韧带后外束股骨止点中心点距股骨髁间窝外侧壁前方、后方和下方软骨缘的距离,再对测量数据进行评估和对比。结果前交叉韧带后外束股骨止点中心点距离股骨前方软骨缘(8.74±1.39)mm,距离后方软骨缘(8.69±1.57)mm（P =0.926）。后外束止点中心点距离股骨下方软骨缘(5.06±0.77)mm。结论膝关节屈膝90°位时,前交叉韧带后外束的股骨止点中心点位于股骨髁间窝外侧壁,距离下方软骨缘5mm,距离前方和后方软骨缘的距离相等。在前交叉韧带双束重建的手术中,应用本研究的结果能够简单、快捷地确定前交叉韧带后外束股骨骨道位置。     

自体髂骨再造桡骨头维持肘关节稳定的生物力学研究

目的研究桡骨头粉碎骨折切除后用自体髂骨再造对肘关节稳定性的生物力学影响。方法新鲜成人尸体上肢标本8侧,制成肘关节"骨-韧带"标本。在外翻力矩2Nm和4 Nm时竖向载荷100N的压力作用下,分别在肘关节不同屈伸位时,用超低压型压力敏感片测量2组试验标本(不同工况)在肘关节外翻时桡骨头及尺骨冠突外侧缘的压力和应力变化,用SPSS 10.0软件作同体配对资料的检验。结果⑴在外翻力矩2 Nm肘关节完整时接触应力为0.75±0.08MPa,A组:先行桡骨头切除后接触应力为1.04±0.11MPa(=3.26,<0.05),行自体髂骨再造桡骨头后接触应力为0.82±0.07MPa(=2.523,>0.05),再行尺侧副韧带切断后接触应力为1.00±0.09MPa(=3.023,<0.05),然后行尺侧副韧带重建后其接触应力为0.84±0.07MPa(=2.612,>0.05),关节基本上能回复原状,肘关节稳定。B组:先行尺侧副韧带切断后接触应力为1.02±0.11MPa(=3.261,<0.05),行桡骨头切除后肘关节明显失稳,再将尺侧副韧带重建,关节接触特征虽有所改善,但影响仍很严重,再行自体髂骨再造桡骨头后标本回复到正常关节接触状态,其接触应力为0.83±0.07MPa(=2.862,>0.05),肘关节稳定。⑵肘关节不同屈伸位时,桡骨头及尺骨冠突外侧缘的压力变化呈力三角形cos30°、cos60°、cos90°、cos120°的变化,与实验组的关节接触特征参数变化规律相一致。⑶在外翻力矩为4 Nm时,关节接触应力值明显增加A组增加1.60倍,B组增加1.48倍,(=3.534,<0.05),关节接触应力曲线与外翻力矩2 Nm时的变化规律相一致。结论自体髂骨再造桡骨头术能恢复肘关节的接触特征,增加关节接触面积,降低外翻应力,增加肘关节的稳定性,可减轻传统桡骨头切除术后的多种并发症,尤其在合并肘关节周围韧带损伤的情况下,有利于改善肘关节的动力学基础,从生物力学角度证明该手术方法是行之有效的。     

Functional anatomy of the lateral collateral ligament complex of the elbow

Postero-lateral instability of the elbow joint is a rare clinical condition, commonly related to a disruption of the lateral collateral ligament complex of the elbow. Twenty elbow joint specimens were studied in order to describe the morphologic characteristics of this complex, and to determine the role of its different components in the stability of the elbow. After a morphologic and morphometric investigation, serial divisions of the medial bundle of the lateral collateral ligament were performed, with or without section of the annular ligament and the anterior bundle of the lateral collateral ligament. The anterior and medial bundles of the lateral collateral ligament had close relationships with the annular ligament and a common proximal course. Isolated section of the medial bundle of the lateral collateral ligament induced only minor laxity of the elbow joint. Combined divisions of the medial and the anterior bundles at their humeral insertion, or the medial bundle and the annular ligament at their ulnar insertion resulted in a reproducible subluxation of the ulno-humeral joint. Thus, postero-lateral rotatory stability of the elbow joint is largely maintained by the lateral collateral ligament complex, composed of three elements: the anterior and medial bundles of the lateral collateral ligament, and the annular ligament. In clinical practice, chronic postero-lateral instability is best treated by a ligamentous reconstruction, that must take into account all these anatomic considerations. We report here a new technique of ligamentoplasty using the fascia of the extensor carpi ulnaris muscle.     

The proximal origins of the flexor–pronator muscles and their role in the dynamic stabilization of the elbow joint: an anatomical study

Purpose

The purpose of this study was to anatomically investigate the proximal origin of flexor–pronator muscles (FPMs) and clarify their contribution to dynamic stabilization of the elbow joint during valgus stress.

Methods

52 elbows from 26 donated formalin-fixed cadavers were examined. The pronator teres muscle (PT), flexor carpi radialis muscle (FCR), palmaris longus muscle (PL), flexor digitorum superficialis muscle (FDS), and flexor carpi ulnaris muscle (FCU) were identified, and their proximal origin and relationship to the anterior bundle of the medial ulna collateral ligament (AOL) were macroscopically and histologically investigated.

Results

The PT, FCR, PL, and FDS converged and formed a common tendon at their proximal origin (the anterior common tendon: ACT). The ACT was attached to the medial epicondyle and the joint capsule, just anterior and parallel to the AOL. The histological morphology of the ACT was quite similar to that of the AOL. The ulnar head of the PT was observed in 48 of 52 elbows (92.3 %), just behind the humeral head of PT. It mainly originated from the anterior edge of the sublime tubercle, while the upper part of ulnar head transitioned directly into the thickened joint capsule just anterior to the AOL.

Conclusion

The proximal attachment of the FPMs had a characteristic morphology. According to our results, the ACT and PT might assist the AOL by sharing static and dynamic traction forces applied to the medial elbow joint.     

锚钉联合骨道技术重建肘关节尺侧副韧带前束的生物力学研究

目的　探讨肘关节尺侧副韧带（ulnar collateral ligament,UCL）前束在完整、断裂、重建三种状态时的肘外翻稳定性,评价锚钉联合骨道重建技术的有效性。 方法　选用8具新鲜成人尸体上肢制成肘关节骨-韧带模型,均先后模拟成UCL前束完整、断裂及锚钉联合骨道技术重建前束3种状态,测量各状态下肘关节在屈曲0°、30°、60°、90°、120°时的生物力学指标,包括外翻松弛度、肱桡关节接触面积、肱桡关节内压强;根据前束的不同状态分为完整组、断裂组、重建组,每组8具标本,将得出的数据进行统计学分析。 结果　组内比较,各组在屈肘0°时的生物力学指标与其余角度比较,差异具有统计学意义（P＜0.05）;组间比较,各组在0°时的生物力学指标比较,差异无统计学意义（P＞0.05）;组间比较,除0°以外的其余角度,完整组与断裂组、重建组与断裂组的生物力学指标差异有统计学意义（P＜0.05）,完整组与重建组的生物力学指标差异无统计学意义（P＞0.05）。 结论　UCL前束是维持肘关节外翻稳定性的重要结构。肘关节在伸直位时较屈曲位处于相对稳定状态。锚钉联合骨道技术重建UCL前束不仅能恢复肘外翻稳定性,而且还具有与正常肘关节同等优良的生物力学特性。     

An aberrant anatomic variation along the course of the ulnar nerve above the elbow with coexistent cubital tunnel syndrome

We report on a patient with an unusual anatomic variation along the course of ulnar nerve above the elbow who had cubital tunnel syndrome. The variation consisted of a cutaneous neural branch that was originating at a distance of approximately 40 mm proximal to the medial epicondyle, and from the radial aspect of the main trunk of ulnar nerve. The branch had a superficial course and it was passing distally, anterior to the medial epicondyle without penetrating the fascia of the flexor muscles origin. Anterior intramuscular transposition of the ulnar nerve was performed leaving the newly found branch over the fascia between the muscles and the adipose subcutaneous tissue.     

The effects of a functional elbow brace on medial joint stability: a case study

Medical elbow ligament sprains in athletics can be traumatic and disabling. In this case report, we outline the effect of a prototype functional elbow brace on joint stability in a female collegiate javelin thrower with an ulnar collateral ligament sprain. A valgus force to both elbows was applied using graded stress radiography (Telos GA-II/E stress device) at 0, 5, 10, and 15 kiloPascals (kPa) of pressure. The increase in gap width between the coronoid process and the medial epicondyle was measured from anteroposterior radiographs to determine medial displacement. The brace resulted in less displacement in both injured and noninjured ulnar collateral ligament; injured ulnar collateral ligament demonstrated greater displacement regardless of condition. The brace restored medial stability to the elbow joint by 49%, 38%, and 35% at 5, 10, and 15 kPa of pressure, respectively. The application of the brace may be useful in athletes with ulnar collateral ligament injuries.     

内窥镜下微创治疗肘管综合征的相关解剖学研究

目的　为内窥镜下进行肘管尺神经减压并前移术提供临床应用解剖基础。 方法　10例新鲜尸体标本、20例临床病例传统手术中尺神经在臂部、前臂游离长度,尺神经第1肌支距离肱骨内上髁的距离、尺神经前移距离。在4例新鲜尸体标本上模拟手术。 结果　此术式尺神经前臂、臂部游离距离为（3.90±0.145）cm（3.64~4.23 cm）、（4.21±0.18）cm（3.80~4.53 cm）,前移距离（1.49±0.05）cm（1.39~1.57 cm）,尺神经第1肌支距离肱骨内上髁距离（2.18±0.38）cm（1.13~2.72cm）。此术式入路点、轴线、层面：肱骨内上髁与尺骨鹰嘴间长约2 cm纵行切口;肱骨内上髁与尺骨鹰嘴之间中点与豌豆骨连线上约7cm长的轴线,肱骨内上髁与尺骨鹰嘴之间中点与肱二头肌内侧肌间隔中点连线上长8cm的轴线;奥本斯韧带、前臂尺侧腕屈肌之间纤维弓形组织表面,臂部深筋膜表面。模拟手术成功。 结论　研究证实此术式可行,达预期效果。     

The lateral collateral ligament complex and related muscles act as a dynamic stabilizer as well as a static supporting structure at the elbow joint: an anatomical and experimental study

Among 71 osteoligamentous elbow joint specimens from Japanese subjects, 66% of the lateral ulnar collateral ligaments (LUCLs) were in an incomplete form, such as a fibrous intermuscular septum lying between the anconeus, supinator and extensors, and terminated on the annular ligament. The 'typical' complete ligament, extending from the lateral epicondyle and over the radial collateral ligament (RCL) to the crista spinatoris, appeared in only 20% of the elbows examined. This observation suggests that, in Japanese subjects, the LUCL is not usually a simple ligamentous static stabilizer, but acts as a dynamic stabilizer, together with its related muscles. In addition, when the elbow was flexed by more than 90 degrees, the distance between the lateral epicondyle and the radial head became almost 1.5 mm larger than the distance from the epicondyle to the annular ligament. We therefore consider that, in the overflexed position, the radial head moves slightly distal while the length of the RCL remains almost constant. This morphometrical observation suggests that the annular ligament needs to be supported by the LUCL-muscle complex from the distal side, as well as by the RCL from the proximal side. This extended definition of the lateral collateral ligament complex and its associated muscular function is discussed.