尺骨冠突骨折对肘关节稳定性的影响  

Experimental study of elbow joint stability following ulna coronoid process fractures

作　　者：王友华[1] 汤锦波[1] 周学军[1] 纪标[1] 刘潘[1] 侍德[1] 

机构地区：[1]南通医学院附属医院骨科,江苏226001

出　　处：《中华骨科杂志》2005年第3期155-158,共4页Chinese Journal of Orthopaedics

基　　金：教育部优秀骨干教师研究基金;江苏省"135"重点科室基金资助项目(2001-34)

摘　　要：目的探讨不同程度尺骨冠突骨折对肘关节稳定性的影响。方法采用11具22侧新鲜成人尸体的上肢标本,在6侧上肢上测量尺骨冠突的高度,滑车切迹开口纵径,开角的大小以及冠突1/2高度处在冠状面的宽度,矢状面的厚度等。在分别距尺骨冠突尖2mm、冠突高1/4处、冠突高1/2处、冠突高3/4处和冠突基底处截骨,测量肘关节的伸屈活动度及稳定性。另16侧上肢随机分成两组,在冠突高1/2处截骨行内固定,一组不修复尺侧副韧带前束,而另一组修复尺侧副韧带前束,分别观测伸屈时肘关节外翻角度的变化。结果尺骨冠突截骨高度不超过冠突高的1/4时,肘关节伸屈稳定性不受影响;当截骨高度达冠突高的1/2以上时,肘关节稳定性明显受影响,活动时会出现半脱位或后脱位,同时尺侧副韧带前束受损;而当尺骨冠突截骨再复位内固定后,尺侧副韧带前束断裂不修复与修复之间,肘关节屈曲0°、30°、60°、90°和120°其外翻角度有显著增加(P<0.05),肘关节不稳定,证实尺侧副韧带前束在抗外翻应力方面有重要作用。结论尺骨冠突骨折不超过冠突原高度的1/4时,对肘关节稳定性无显著影响,有手术摘除碎骨片不会影响肘关节功能;当尺骨冠突骨折超过原高度的1/2合并有尺侧副韧带前束损伤时,会明显影响肘关节稳定性,在行复位内固定的同时,应修补或重建韧带以稳定?Objective To evalvate the influence of elbow joint stability following ulna coronoid process fractures. Methods Three cadaveric upper extremities were used. The height, width, thickness, diameter and opening angle of ulna coronoid process were measured in six arms, while the coronoid process fragments at the level of 2 mm, quarter, half, three quarter and whole height were resected consecutively, the changes of the range of the elbow joint movement were recorded. Another sixteen specimens were divided into two groups: the anterior bundle of the ulnar collateral ligaments (UCL) in one group was unrepaired; While the other repaired, then the angle of cubitus valgus between two groups was compared. Results If the osteotomy bone was within quarter of ulna coronoid process, the elbow joint function was good. However, in cases of osteotomy on half of coronoid process, the elbow extension function was limited and the elbow became unstable. After reduction with internal fixation, the angle of cubitus valgus was greater in the second group, and the difference of elbow joint in flexion 0°, 30°, 60°, 90° and 120° had statistical significance(P< 0.05). The elbow became unstabe. Conclusion If the osteotomy is made within quarter of ulna coronoid process, elbow stability is not affected; If it exceeds half of coronoid process, the injury of anterior bundle of UCL is possible, elbow instability will occur, the fracture should be reduced with internal fixation and the ligament must be repaired or reconstructed. In cases of the destrcuction of coronoid process, bone reconstruction is necessary to regain the elbow stability.

关 键 词：肘关节 尺骨 韧带 截骨 骨折 影响 上肢 前束 高度 开角 

分 类 号：R683[医药卫生—骨科学]