Tomaino Matthew M, Pfaeffle Jamie, Stabile Kathryne, Li Zong-Ming
Department of Orthopaedic Surgery, Musculoskeletal Research Center, University of Pittsburgh Health System, USA.
J Hand Surg Br. 2003 Jun;28(3):267-70. doi: 10.1016/s0266-7681(03)00012-3.
Excision of the radial head after fracture may be complicated by longitudinal radio-ulnar instability (Essex-Lopresti lesion) if the forearm interosseous ligament has also been torn. In such cases proximal migration of the radius occurs, and ulnar impaction at the wrist and radiocapitellar contact at the elbow may impair function. Although metal radial head arthroplasties are now used for irreparable radial head fractures, the long-term clinical outcome may still be unsatisfactory because of excessive radiocapitellar load causing pain. Interosseous ligament reconstruction might improve outcome by restoring normal load transfer from the radius to ulna, but the biomechanical effect of reconstruction has not been reported. This study evaluated forearm load transfer following interosseous ligament reconstruction with an Achilles tendon allograft in a cadaveric model with the radial head intact. Interosseous ligament reconstruction reduced proximal radius loading by transferring force to the proximal ulna, but force transfer by the reconstruction was only half that by the intact ligament.
如果前臂骨间韧带也已撕裂，桡骨小头骨折后行桡骨小头切除术可能会并发桡尺骨纵向不稳定（埃塞克斯-洛普雷斯蒂损伤）。在这种情况下，桡骨会向近端移位，腕部的尺骨撞击以及肘部的桡骨头关节面接触可能会损害功能。尽管现在金属桡骨小头置换术用于无法修复的桡骨小头骨折，但由于桡骨头关节面负荷过大导致疼痛，长期临床疗效可能仍不令人满意。骨间韧带重建可能通过恢复从桡骨到尺骨的正常负荷传递来改善疗效，但重建的生物力学效果尚未见报道。本研究在桡骨小头完整的尸体模型中评估了同种异体跟腱重建骨间韧带后前臂的负荷传递情况。骨间韧带重建通过将力传递至尺骨近端减少了桡骨近端的负荷，但重建后的力传递仅为完整韧带的一半。
