[肘关节重建后外翻稳定性的生物力学评估]

Jiang Tao, Huang Fuguo, Peng Jiaying, Zhong Yilin, Xu Jianhua

Department of Orthopaedic Surgery, the Third People's Hospital of Mianyang, Mianyang Sichuan, 621000, PR China.

Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi. 2005 Feb;19(2):141-4.

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: (1) intact (n=12); (2) release of the medial collateral ligament (n=6); (3) excision of the radial head (n=6); (4) excision of the radial head together with release of the medial collateral ligament (n=12); (5) radial head replacement (n=6); (6) medial collateral ligament reconstruction (n=6); (7) radial 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, the reconstruction of the medial collateral ligament is acceptable.

目的

评估桡骨头切除、内侧副韧带（MCL）松解、桡骨头置换及内侧副韧带重建术后肘关节的外翻稳定性。

方法

解剖12具新鲜人体尸体肘关节，建立7种含有关节和韧带的标本，如下：（1）完整标本（n = 12）；（2）内侧副韧带松解标本（n = 6）；（3）桡骨头切除标本（n = 6）；（4）桡骨头切除联合内侧副韧带松解标本（n = 12）；（5）桡骨头置换标本（n = 6）；（6）内侧副韧带重建标本（n = 6）；（7）桡骨头置换联合内侧副韧带重建标本（n = 12）。在前臂旋后位，施加2牛顿米的外翻扭矩，于0、30、60、90和120度屈曲位时，对肘关节外翻松弛度进行量化：所有分析均使用SPSS 10.0软件进行。

结果

完整状态下外翻松弛度最小，稳定性最佳。桡骨头切除后松弛度增加。内侧副韧带松解后的松弛度大于桡骨头切除后的松弛度（P < 0.01）。内侧副韧带松解联合桡骨头切除后松弛度最大，稳定性最差。随后进行桡骨头置换后松弛度降低。内侧副韧带重建后的松弛度与完整韧带时相当（P > 0.05）。桡骨头置换联合内侧副韧带重建后的松弛度变小。