Soubeyrand Marc, Lafont Clarisse, De Georges Renaud, Dumontier Christian
Service d'orthopédie, hôpital du Kremlin-Bicêtre, 78, rue du Général-Leclerc, 94270 Le Kremlin-Bicêtre, France.
Chir Main. 2007 Dec;26(6):255-77. doi: 10.1016/j.main.2007.09.004. Epub 2007 Oct 22.
The antibrachial interosseous membrane (IOM) is taught over an average length of 10.6cm between the diaphyses of the radius and ulna bone. It looks like a stitch with fibers running from the ulna to the radius and from proximal to distal and fibers running from distal to proximal. The central band, which is the middle part of the fibers directed from distal to proximal has mechanical properties similar to those of a ligament and act as a ligamentous structure embedded in the larger membranous complex of the IOM. The interosseous membrane has a double function: it stabilizes transversally the forearm's two bones and stabilizes longitudinally the two bones by transferring loads from the radius to the ulna. Load transmission varies according to the prono-supination position, the varus-valgus constraints on the elbow and the inclination of the wrist, making interpretation of the experimental data difficult. One should consider the forearm as a whole and the interosseous membrane with the two diaphyses should be regarded as a middle radio-ulnar joint, intercalated between the proximal and distal radio-ulnar joint. Those three articulations or links between radius and ulna act synergistically to stabilize and optimize repartition of loads. Functional loss of one of these links, and of course of more than one, will severely modify the forearm function. Essex-Lopresti lesion, which represents the functional loss of all three links, is the most destabilizing forearm lesion. Imaging of the interosseous membrane is difficult. MRI allows for static imaging of the interosseous membrane but there are often artifacts due to previous trauma or surgical procedures. Dynamic sonography helps to visualize all the lesions and will probably be part of the evaluation of every severe forearm injury. Surgical treatment depends on the gravity of the lesions of the different links. Interosseous membrane reconstruction is still the most difficult technique and most of the previously reported ligamentoplasties cannot answer all the biomechanical constraints. We describe a ligamentoplasty based on the biomechanics whose technique has been validated by cadaveric experiments. First surgical cases are promising.
前臂骨间膜（IOM）在桡骨和尺骨干之间的平均长度为10.6厘米。它看起来像一针缝线，纤维从尺骨向桡骨、从近端向远端以及从远端向近端走行。中央束是纤维从远端向近端走行的中间部分，其力学性能类似于韧带，起到嵌入IOM较大膜性复合体中的韧带结构的作用。骨间膜具有双重功能：它横向稳定前臂的两块骨头，并通过将负荷从桡骨传递到尺骨纵向稳定这两块骨头。负荷传递根据旋前 - 旋后位置、肘部的内翻 - 外翻限制以及腕部的倾斜度而变化，这使得对实验数据的解释变得困难。应将前臂视为一个整体，带有两个骨干的骨间膜应被视为介于近端和远端桡尺关节之间的中间桡尺关节。桡骨和尺骨之间的这三个关节或连接协同作用以稳定和优化负荷分配。这些连接中的一个（当然不止一个）功能丧失将严重改变前臂功能。埃塞克斯 - 洛普雷斯蒂损伤代表所有三个连接的功能丧失，是最不稳定的前臂损伤。骨间膜的成像很困难。MRI可以对骨间膜进行静态成像，但由于先前的创伤或手术操作，常常会出现伪影。动态超声有助于观察所有损伤，可能会成为每例严重前臂损伤评估的一部分。手术治疗取决于不同连接损伤的严重程度。骨间膜重建仍然是最困难的技术，而且之前报道的大多数韧带成形术都无法满足所有的生物力学要求。我们描述了一种基于生物力学的韧带成形术，其技术已通过尸体实验验证。首批手术病例前景良好。
