桡侧腕长伸肌肌腱重建骨间膜结合桡骨头置换恢复前臂纵向稳定性的生物力学研究  

A BIOMECHANICAL STUDY ON RECONSTRUCTION OF FOREARM INTEROSSEOUS MEMBRANE USING EXTENSOR CARPI RADIALIS LONGUS COMBINED WITH RADIAL HEAD REPLACEMENT FOR RESTORING FOREARM LONGITUDINAL STABILITY

作　　者：郭建邦 赵友明[2] 李晓彬 武兴国 刘奕宁 

机构地区：[1]梅州市中医医院骨科,广东梅州514000 [2]温州医科大学附属第二医院骨科

出　　处：《中国修复重建外科杂志》2016年第7期804-808,共5页Chinese Journal of Reparative and Reconstructive Surgery

基　　金：梅州市科技计划项目(2015B007)~~

摘　　要：目的通过生物力学测试,评价桡侧腕长伸肌肌腱重建前臂骨间膜结合桡骨头置换恢复前臂纵向稳定性的效果。方法取10具新鲜冰冻成人前臂标本,男8具,女2具;年龄29~74岁,平均38.2岁。每个标本依次作以下处理:切除桡骨头(A组)、切除桡骨头+分离远侧尺桡关节(B组)、切除桡骨头+分离远侧尺桡关节+切除骨间膜中央束(C组)、桡侧腕长伸肌肌腱重建骨间膜(D组)、单纯桡骨头置换(E组)、桡侧腕长伸肌肌腱重建骨间膜+桡骨头置换(F组)。大体观察各组标本制备后在负荷及非负荷状态下,尺桡骨间距以及尺桡关节移位情况;行生物力学测试,记录桡骨向近端移位5 mm时施加在标本两端的负荷。结果恢复桡骨长度可以维持正常尺桡骨间距,骨间膜重建可以恢复尺桡骨间的负荷传导。生物力学测试显示,A^F组桡骨向近端移位5 mm所需负荷分别为(74.507±4.967)、(49.227±1.940)、(17.827±1.496)、(24.561±1.390)、(140.247±8.029)、(158.423±9.142)N,各组间比较差异均有统计学意义(P<0.01)。结论单纯桡侧腕长伸肌肌腱重建骨间膜不能恢复前臂纵向稳定,而其联合桡骨头置换可有效重建前臂纵向稳定性。Objective To evaluate the effect of reconstruction of forearm interosseous membrane（IOM） using extensor carpi radialis longus combined with radial head replacement for restoring the forearm longitudinal stability. Methods Ten fresh-frozen adult cadaveric forearms were selected, including 8 males and 2 females with a mean age of 38.2 years（range, 29-74 years）. Each forearm was treated as following steps： radial head excision（group A）, radial head excision＋the distal ulnar radial joints separation（group B）, radial head excision＋the distal ulnar radial joints separation＋IOM central band excision（group C）, reconstructed IOM with extensor carpi radialis longus tendon（group D）, radial head prothesis replacement（group E）, and reconstructed IOM with extensor carpi radialis longus tendon＋radial head prothesis replacement（group F）. The distance between ulna and radius and radioulnar joint displacement were observed under load and non load. The force loading on both ends of specimen was recorded when the radius shifted 5 mm proximally. Results Restoring the radial length could maintain normal distance between radius and ulna. The interosseous membrance reconstruction could restore the load transmission between radius and ulna. The force loading specimen was（74.507±4.967）,（49.227±1.940）,（17.827±1.496）,（24.561±1.390）,（140.247±8.029）, and（158.423±9.142）N in groups A, B, C, D, E, and F respectively when the radius shifted 5 mm proximally, showing significant difference among groups（P〈0.01）. Conclusion Reconstruction of the IOM with the extensor carpi radialis longus tendon is insufficient to restore the forearm longitudinal stability. Reconstruction using extensor carpi radialis longus tendon combined with radial head replacement may be a new choice for treatment of forearm longitudinal instability.

关 键 词：前臂骨间膜 桡侧腕长伸肌 桡骨头置换 生物力学 

分 类 号：R687[医药卫生—骨科学] R318.01[医药卫生—外科学]