冠突骨折行桡骨小头切除对肘关节稳定性的实验研究  

Experimental study of the elbow joint stability on the experimental excision of the radial head in the case of coronoid process fractures

作　　者：宋景仑[1] 王鹏程[1] 张奉琪[1] 

机构地区：[1]河北金能邢矿集团总医院骨科,河北邢台054000

出　　处：《中国矫形外科杂志》2007年第18期1412-1414,共3页Orthopedic Journal of China

基　　金：河北省科技厅攻关项目(No.052761665)

摘　　要：[目的]桡骨小头粉碎骨折时往往行桡骨小头切除术。本研究目的是分析桡骨小头粉碎骨折伴尺骨冠突骨折时行桡骨小头切除前后肘关节的稳定性。[方法]选取骨密度值相近的上肢标本20对,经X线片证实无风湿、结核、肿瘤、骨折、畸形等。剥离上肢所有的皮肤、肌肉和筋膜,完整保留肘关节囊、内外侧副韧带、环状韧带及尺、桡骨骨间膜。调制好的牙托粉与标本两端固定后,将标本伸直侧位自由放置于生物力学机,关节轴与水平面垂直,肱骨外髁向上,于肱骨外髁处垂直向下载荷,记录肘外翻位移。将标本竖直固定于生物力学机,尺桡骨向下,肘关节伸直位,做肘外旋扭转,记录肘关节的转角。[结果]桡骨小头粉碎骨折伴冠突无骨折、Ⅰ型骨折、Ⅱ型骨折在桡骨小头切除后较切除前肘外翻位移及外旋角经统计学比较各组间并无显著性差异;伴冠突Ⅲ型骨折时在桡骨小头切除后较切除前肘外翻位移及外旋角显著增大。[结论]桡骨小头粉碎骨折伴冠突Ⅰ、Ⅱ型骨折行桡骨小头切除前后肘关节均稳定,可行桡骨小头切除术,Ⅲ型骨折不稳定,应修复桡骨小头或假体置换,并修复冠突及尺桡侧副韧带。　[Objective]To determine the elbow joint stability of the radial head comminuted fracture with various types of the coronoid process fractures after experimental excision of the radial head. [Method]Twenty pairs of embalmed anatomic specimen epipods which had similar bone density scanned by DEXA were selected. Skin,muscles and fasciae were stripped while reserving the full of articular capsule,MCL and LCL,AL and inter-osseus membrance between Ulna and radius; Deformation,tumor and fracture were not found in all specimens. After the both ends of the specimen were fixed by the modulated dental base acrylic resin powder. Specimen keeping a extension-lateral position were placed in the both ends of the level support of the biomechanics machine freely. The joint axis were vertical to horizontal plane. The humerus lateral epicondyle was up and imposed vertically by the machine while the elbow eversion displacement was recorded . After the specimen were fixed in the biomechanics machine vertically while the ulna and radius were down and the elbow joint were stretched,the elbow was made external rotation and the comer of the elbow joint was recorded.[Result]The elbow eversion displacement and extemalrotation comer were not statistically significant difference among the coronoid process no fracture,the type Ⅰ fracture and the type Ⅱ fracture before and after experimental excision of the radial head,but the elbow eversion displacement and extemalrotation comer of the type Ⅲ fracture were significantly increased.[Conclusion]Under the condition of the radial head comminuted fracture with coronoid process fractures： with the type Ⅰ fracture and the type Ⅱ coronoid process fracture,the elbows are stable before and after experimental excision of the radial head,thus the radial head excision could be advocated; with the type Ⅲ coronoid process fracture the elbows are unsteady,thus the radial head fracture or the prosthetic replacement should be suggested combined with treatment of coronoid process fracture,MCL an

关 键 词：肘关节 桡骨小头 尺骨冠突 骨折 生物力学 

分 类 号：R687.4[医药卫生—骨科学]