Charalambous C P, Stanley J K, Siddique I, Powell E, Ramamurthy C, Gagey O
Centre for Hand and Upper Limb Surgery, Wrightington Hospital, UK.
Injury. 2006 Sep;37(9):849-53. doi: 10.1016/j.injury.2006.04.125. Epub 2006 Jul 26.
A widely used clinical recommendation is that in the presence of medial collateral ligament injuries, two-part radial head fractures should be fixed rather than excising or replacing the radial head. Direct biomechanical data comparing fracture fixation, radial head replacement and excision in a human cadaveric elbow model, have not been previously described. Such comparison is clinically important as with the increasing availability of radial head implants and promising follow up results, the role of radial head replacement in fracture management may have to be redefined. In this study, five fresh cadaveric elbows had radial head fracture creation and medial collateral ligament division, fracture fixation, radial head replacement and excision. Valgus and varus laxity were determined using an electromagnetic tracking system. Radial head replacement leads to a similar valgus (P=0.80) [corrected] laxity as compared to radial head fixation. Radial head excision resulted in a significantly greater valgus laxity as compared to radial head fixation (P=0.02) or replacement (P=0.03). Both radial head excision and replacement led to a greater varus laxity as compared to fixation. Our results suggest that in the elbow with medial collateral ligament injury and two-part radial head fracture, fixation is overall biomechanically superior as compared to replacement and excision.
一个广泛应用的临床建议是，在存在内侧副韧带损伤的情况下，对于两部分型桡骨头骨折应进行固定，而不是切除或置换桡骨头。此前尚未有在人体尸体肘部模型中比较骨折固定、桡骨头置换和切除的直接生物力学数据描述。这种比较在临床上很重要，因为随着桡骨头植入物的可用性增加以及有前景的随访结果，桡骨头置换在骨折治疗中的作用可能需要重新定义。在本研究中，对五个新鲜尸体肘部造成桡骨头骨折并切断内侧副韧带，然后进行骨折固定、桡骨头置换和切除。使用电磁跟踪系统测定外翻和内翻松弛度。与桡骨头固定相比，桡骨头置换导致的外翻（P = 0.80）[校正后]松弛度相似。与桡骨头固定（P = 0.02）或置换（P = 0.03）相比，桡骨头切除导致的外翻松弛度明显更大。与固定相比，桡骨头切除和置换均导致更大的内翻松弛度。我们的结果表明，在存在内侧副韧带损伤和两部分型桡骨头骨折的肘部，与置换和切除相比，固定在整体生物力学上更具优势。
