Beingessner Daphne M, Dunning Cynthia E, Stacpoole Rebecca A, Johnson James A, King Graham J W
Department of Orthopaedics and Sports Medicine, Harborview Medical Center, University of Washington, 325 9th Avenue, Box 359798, Seattle, WA 98104, USA.
Clin Biomech (Bristol). 2007 Feb;22(2):183-90. doi: 10.1016/j.clinbiomech.2006.09.007. Epub 2006 Nov 13.
Coronoid fractures often occur in the setting of more complex elbow trauma. Little is known about the influence of coronoid fracture size on elbow kinematics, particularly in the setting of concomitant ligament injuries. The purpose of this study was to determine the effect of coronoid fractures on elbow kinematics and stability in ligamentously intact and medial collateral ligament deficient elbows and to determine the effect of forearm position on elbow stability in the setting of coronoid fracture.
Eight cadaveric arms were tested during simulated active dependent elbow motion and gravity-loaded passive elbow motion. Kinematic data were collected from an electromagnetic tracking system. The protocol was performed in ligament origin repaired and medial collateral ligament deficient elbows with radial head arthroplasty. Testing was carried out with the coronoid intact, and with 10% (Type I), 50% (Type II), and 90% (Type III) removed. Varus-valgus angulation of the ulna relative to the humerus and maximum varus-valgus laxity were measured.
With repaired ligament origins and medial collateral ligament deficiency, there was increased varus angulation and increased maximum varus-valgus laxity following simulation of a Type II and Type III coronoid fracture. There was less kinematic change with the forearm in supination than in pronation.
Elbow kinematics are altered with increasing coronoid fracture size. Repair of Type II and Type III coronoid fractures as well as lateral ligament repair is recommended where possible. Forearm supination may be considered during rehabilitation following coronoid repair. Valgus elbow positioning should be avoided if the medial collateral ligament is not repaired.
冠突骨折常发生于更为复杂的肘部创伤情况中。关于冠突骨折大小对肘部运动学的影响，尤其是在合并韧带损伤的情况下，人们了解甚少。本研究的目的是确定冠突骨折对韧带完整和内侧副韧带损伤的肘部的运动学及稳定性的影响，并确定在冠突骨折情况下前臂位置对肘部稳定性的影响。
在模拟主动下垂肘部运动和重力加载被动肘部运动过程中，对8具尸体手臂进行测试。通过电磁跟踪系统收集运动学数据。该方案在韧带起点修复且内侧副韧带损伤并进行桡骨头置换的肘部进行。在冠突完整、切除10%（I型）、50%（II型）和90%（III型）的情况下进行测试。测量尺骨相对于肱骨的内翻-外翻角度及最大内翻-外翻松弛度。
在韧带起点修复且内侧副韧带损伤的情况下，模拟II型和III型冠突骨折后，内翻角度增加，最大内翻-外翻松弛度增加。前臂旋后时的运动学变化小于旋前时。
随着冠突骨折大小增加，肘部运动学发生改变。建议尽可能修复II型和III型冠突骨折以及外侧韧带。冠突修复后的康复过程中可考虑前臂旋后。如果内侧副韧带未修复，应避免肘部外翻位。
