重建肘关节外翻稳定性的生物力学研究  

BIOMECHANICAL EVALUATION OF THE VALGUS STABILITY OF ELBOW AFTER RECONSTRUCTION

作　　者：蒋涛[1] 黄富国[2] 彭加英[1] 钟易林[1] 徐建华[1] 

机构地区：[1]绵阳市第三人民医院,四川绵阳621000 [2]四川大学华西医院骨科

出　　处：《中国修复重建外科杂志》2005年第2期141-144,共4页Chinese Journal of Reparative and Reconstructive Surgery

摘　　要：目的　评价肘关节桡骨头 (radial head,RH)切除、尺侧副韧带 (medial collateral ligament,MCL )损伤以及 RH假体置换、MCL重建后的外翻稳定性。　方法　新鲜成人尸体上肢标本 12侧 ,制成肘关节“骨 -韧带”标本 ,在2 N· m的外翻力矩作用下 ,分别在肘关节 0°、30°、6 0°、90°和 12 0°伸屈时 ,测量肘关节外翻松弛度 :1完整肘关节(n=12 ) ;2 MCL切断 (n=6 ) ;3RH切除 (n=6 ) ;4 MCL切断 +RH切除 (n=12 ) ;5 RH假体置换 (n=6 ) ;6 MCL重建(n=6 ) ;7RH假体置换 +MCL重建 (n=12 )。用 SPSS 10 .0统计软件包作方差分析 ,比较各组的外翻稳定性。　结果　完整肘关节的平均外翻松弛度最小 ;RH切除后 ,外翻松弛度增大 ;单纯 MCL切断 ,外翻松弛度大于单纯 RH切除 (P<0 .0 1) ;MCL切断 +RH切除 ,外翻稳定性最差 ;行 RH假体置换 ,对稳定性有改善 ;MCL重建与完整 MCL差异无统计学意义 (P>0 .0 5 ) ;RH假体置换同时重建 MCL ,效果最好。　结论　 MCL是抵抗肘关节外翻应力最主要的因素 ,RH是次要因素。在重建肘关节的外翻稳定性方面 ,MCL的重建比 RH的假体置换更重要。在无条件行 RH假体置换时 ,修复MCL是较好的手术方式。Objective To evaluate of the valgus stability of the elbow after excision of the radial head, release of the medial collateral ligament (MCL), radial head replacement, and medial collateral ligament reconstruction. Methods Twelve fresh human cadaveric elbows were dissected to establish 7 kinds of specimens with elbow joint and ligaments as follow:①intact(?n=12)?? ②release of the medial collateral ligament(?n=6)??￠? excision of the radial heada(c)(?n=6)?? ④excision of the radial head together with release of the medial collateral ligament(?n=12)??⑤radial head replacement(?n=6)??⑥medial collateral ligament reconstruction(?n=6)??⑦radial head replacement together with medial collateral ligament reconstruction(?n=12)?. Under two newton meter valgus torque, and at 0, 30, 60, 90 and 120 degrees of flexion with the forearm in supination, the valgus elbow laxity was quantified: All analysis was performed with SPSS 10.0 software. Results The least valgus laxity was seen in the intact state and its stability was the best. The laxity increased after resection of the radial head. The laxity was more after release of the medial collateral ligament than after resection of the radial head (?P?<0.01). The greatest laxity was observed after release of the medial collateral ligament together with resection of the radial head, so its stability was the worst. The laxity of the following implant of the radial head decreased. The laxity of the medial collateral ligament reconstruction was as much as that of the intact ligament (?P?>0.05). The laxity of the radial head replacement together with medial collateral ligament reconstruction became less. Conclusion The results of this study show that the medial collateral ligament is the primary valgus stabilizer of the elbow and the radial head was a secondary constraint to resist valgus laxity. Both the medial collateral ligament reconstruction and the radial head replacement can restore the stability of elbow. If the radial head replacement can not be carried out,

关 键 词：肘关节 假体置换 RH 切除 重建 韧带 生物力学 标本 抵抗 

分 类 号：R687[医药卫生—骨科学]