St. David's Hospital Round Rock, Round Rock, TX 78681, USA.
J Shoulder Elbow Surg. 2011 Mar;20(2):226-33. doi: 10.1016/j.jse.2010.09.011.
Complete ulnar collateral ligament (UCL) injury increases articular pressure and reduces contact area compared with the normal intact UCL. UCL reconstruction restores the contact area and contact pressure observed in the native joint.
Six male cadaveric elbows were mounted on a custom jig capable of simulating the 2 critical phases of the throwing motion during pitching. A contact sensor was placed through an anterior arthrotomy into the radiocapitellar joint. Each specimen then underwent valgus loading at 1.75 and 5.25 Nm of torque with the biceps, brachialis, and triceps under axial load in each testing condition.
The average valgus laxity in the intact elbow at 90° was 3.7° ± 0.6° at the 5.25 Nm level of torque, which doubled after transection. The reconstruction group demonstrated less laxity (2.4° ± 0.4°) and reduced valgus angulation of the ulna at 5.25 Nm of torque. The transected UCL condition showed peak contact pressure 67% higher compared with the native ligament group at 5.25 Nm of torque. The reconstructed group increased peak articular cartilage pressures by 33% from the native ligament. At 5.25 Nm of torque for the 90° flexion phase, the transected UCL condition showed an average contact pressure of 84% greater than that of the native ligament group. Reconstruction of the UCL restored average articular pressures to within 20% of intact values at 90°.
UCL injury increases radiocapitellar contact pressures and reduces resistance of the elbow to valgus loading. Contact pressures and valgus laxity can be improved with UCL reconstruction.
Taken as a whole, the peak pressure data indicate that the reconstruction restores valgus stability and lateral contact pressures to nearly normal levels under the conditions tested. Because the 90 position is the clinically significant position, these laboratory data support the clinical success of the docking procedure.
与正常完整的 UCL 相比，完全 UCL 损伤会增加关节压力并减少接触面积。UCL 重建恢复了在原生关节中观察到的接触面积和接触压力。
将 6 个男性尸体肘部安装在一个定制的夹具上，该夹具能够模拟投球过程中的 2 个关键阶段。通过前关节切开术将一个接触传感器放置在桡尺骨关节中。在每种测试条件下，每个标本都在肱二头肌、肱肌和三头肌的轴向载荷下以 1.75 和 5.25Nm 的扭矩进行外翻加载。
在 90°时，完整肘部的平均外翻松弛度在 5.25Nm 扭矩水平下为 3.7°±0.6°，在横断后增加了一倍。重建组的松弛度较小（2.4°±0.4°），在 5.25Nm 的扭矩下，尺骨的外翻角度减小。在 5.25Nm 的扭矩下，横断 UCL 条件下的峰值接触压力比原生韧带组高 67%。与原生韧带相比，重建组的关节软骨峰值压力增加了 33%。在 90°屈曲阶段，5.25Nm 的扭矩下，横断 UCL 条件下的平均接触压力比原生韧带组高 84%。UCL 的重建将关节压力恢复到接近 90°时的正常水平。
UCL 损伤会增加桡尺骨关节的接触压力，并降低肘部对抗外翻载荷的阻力。UCL 重建可以改善接触压力和外翻松弛度。
总的来说，峰值压力数据表明，重建术在测试条件下将外翻稳定性和外侧接触压力恢复到接近正常水平。由于 90 度位置是临床上重要的位置，这些实验室数据支持对接手术的临床成功。
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