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；将16侧上肢标本分为两组，通过生物力学试验，研究按顺序切断桡侧软组织结构时肘关节旋转度的变化。结果 肘关节伸肌起始于肱骨外髁的肌腱膜上，肌腱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；桡侧副韧止于尺骨冠突的部分为桡侧尺副韧带，其与桡骨环状韧带在尺度上的止点有2种类型。肘关节桡侧副韧带复合体对维持关节外侧稳定的作用约占50％，伸肌及伸肌腱膜的作用约占11％；在桡侧副韧带复合体中，桡侧副韧带（包括桡侧尺副韧带）起主要作用，桡骨环状韧带起协同作用。结论 肘关节后侧旋转不稳定除桡侧副韧带的损伤外，可能还有外侧伸肌及伸肌腱膜的损伤。

Study on anatomical structure and biomechanics of posterolateral rotatory instability of elbow

Objective To study the effect of lateral soft tissue on the rotatory stability of the elbow joint. Methods The characteristics of the lateral soft tissue of elbow was studied through anatomizing the elbow joint, and the change of the rotatory degree of the elbow was also studied when the structure of the radial soft tissue was cut off orderly. Results The musculus extensor of the elbow joint originated from the muscle tendon membrane of the external condyle of humerus. One part of the muscle tendon membrane turned into the intermuscular septum and another part stopped at the external bone surface of the olecranon. The radial collateral ligament stopping at the corocoid process of ulnar came into being the radial-ulnaris collateral ligament, and there were two types of stopping points of the radial-ulnaris collateral ligament and the annular ligament of radius on the ulna.In the radial collateral ligament complex, the radial collateral ligament plays the major role (including the radial-ulnaris collateral ligament) and the annular ligament of radius plays the synergistic action. Conclusions Besides the injury of the radial collateral ligament, the injuries of the external musculus extensor and the aponeurosis can cause the posterolateral rotatory instability of the elbow.