Drake Matthew L, Farber Gerald L, White Kacey L, Parks Brent G, Segalman Keith A
Curtis National Hand Center, Union Memorial Hospital, Baltimore, MD, USA.
J Hand Surg Am. 2010 Dec;35(12):1981-5. doi: 10.1016/j.jhsa.2010.09.009.
This study proposed a method of restoring the longitudinal stability of the forearm provided by the central band of the interosseous membrane (IOM) by using a percutaneously placed suture button construct. We hypothesized that supporting the forearm IOM with a suture button construct would restore longitudinal stability in a cadaveric model of the Essex-Lopresti lesion.
We assessed 7 adult cadaver upper extremities radiographically for evidence of previous elbow, forearm, or wrist fracture. Each limb was mounted onto a materials testing system with the elbow held at 90° and the forearm in neutral. The intact specimen was loaded cyclically at 134 N to determine the native mobility of the forearm segment. Each specimen was tested after each of the following steps: radial head removal, transection of the IOM, and suture button construct reconstruction of the IOM. After the final reconstruction, each specimen was examined for forearm range of motion and evidence of neurovascular injury.
Removal of the radial head and sectioning of the IOM sequentially increased average proximal migration of the radius by 3.6 and 7.1 mm, respectively. After reconstruction with the suture button construct, the IOM was restored to the intact state with only the radial head removed. Forearm rotation was not compromised by the reconstruction, and there was no evidence of neurovascular injury in any specimen.
A percutaneously placed suture button construct can restore the longitudinal stability provided by an IOM. The method described did not limit forearm rotation. We encountered no neurovascular injury in the specimens tested in this series. This construct may be an effective adjunct when combined with bony reconstruction to treat longitudinal forearm axis injuries.
本研究提出了一种通过经皮放置缝线纽扣结构来恢复骨间膜（IOM）中央束所提供的前臂纵向稳定性的方法。我们假设在埃塞克斯-洛普雷斯蒂损伤的尸体模型中，用缝线纽扣结构支撑前臂IOM可恢复纵向稳定性。
我们对7具成年尸体的上肢进行了影像学评估，以寻找既往肘部、前臂或腕部骨折的证据。将每个肢体安装在材料测试系统上，肘部保持在90°，前臂处于中立位。对完整的标本施加134 N的循环载荷，以确定前臂节段的自然活动度。在以下每个步骤后对每个标本进行测试：桡骨头切除、IOM横断以及IOM的缝线纽扣结构重建。在最终重建后，检查每个标本的前臂活动范围以及神经血管损伤的证据。
桡骨头切除和IOM横断分别使桡骨近端平均移位依次增加3.6和7.1 mm。在用缝线纽扣结构重建后，仅切除桡骨头的情况下，IOM恢复到了完整状态。重建未影响前臂旋转，且任何标本均未发现神经血管损伤的证据。
经皮放置的缝线纽扣结构可恢复IOM所提供的纵向稳定性。所描述的方法未限制前臂旋转。在本系列测试的标本中，我们未遇到神经血管损伤。当与骨重建联合用于治疗前臂纵轴损伤时，这种结构可能是一种有效的辅助手段。
