Pollock J Whitcomb, Pichora Jamie, Brownhill Jamie, Ferreira Louis M, McDonald C P, Johnson James A, King Graham J
The Ottawa Hospital, General Campus, Ottawa, Ontario, Canada.
J Shoulder Elbow Surg. 2009 May-Jun;18(3):408-17. doi: 10.1016/j.jse.2009.01.009.
This study determined whether elbow stability could be restored with open reduction and internal fixation (ORIF) of type II coronoid fractures and evaluated the role of collateral ligament repair.
Passive varus and valgus and simulated active vertical motion were performed using an in vitro elbow motion simulator. Varus/valgus angle and internal/external rotation were measured with the coronoid intact, with 50% removed, and after ORIF. Testing was performed with the collateral ligaments detached and repaired.
Vertical: stability was normal when both the lateral collateral ligament (LCL) and medial collateral ligament (MCL) were repaired, irrespective of the coronoid state. Kinematics were altered with a repaired LCL, incompetent MCL, and type II coronoid fracture (P < .05). Varus: LCL repair restored coronal stability but did not restore internal rotation (P < .05).
These findings suggest that repair of type II coronoid fractures and injured collateral ligaments should be performed where possible. Over-tensioning the LCL, in the setting of MCL and coronoid deficiency, may contribute to instability.
本研究确定Ⅱ型冠突骨折切开复位内固定（ORIF）能否恢复肘关节稳定性，并评估侧副韧带修复的作用。
使用体外肘关节运动模拟器进行被动内翻和外翻以及模拟主动垂直运动。在冠突完整、切除50%以及ORIF后，测量内翻/外翻角度和内/外旋转。在侧副韧带切断和修复的情况下进行测试。
垂直方向：当外侧副韧带（LCL）和内侧副韧带（MCL）均修复时，稳定性正常，与冠突状态无关。修复的LCL、功能不全的MCL和Ⅱ型冠突骨折会改变运动学（P <.05）。内翻方向：LCL修复恢复了冠状面稳定性，但未恢复内旋（P <.05）。
这些发现表明，Ⅱ型冠突骨折和损伤的侧副韧带应尽可能进行修复。在MCL和冠突缺损的情况下过度拉紧LCL可能会导致不稳定。
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