Nwoko Okechukwu E, Patel Priyesh P, Richard Marc J, Leversedge Fraser J
Department of Orthopaedic Surgery, Duke University, Durham, NC 27710, USA.
J Hand Surg Am. 2013 Jul;38(7):1315-9. doi: 10.1016/j.jhsa.2013.04.008.
To evaluate the potential use of the longer tendinous insertion of the superficial head of the brachialis as a local graft source for elbow annular ligament reconstruction.
The tendon of the superficial head of the brachialis muscle was harvested as a distally based graft in 24 unmatched, fresh-frozen cadaveric specimens. The tendon insertion on the proximal ulna was preserved, and the graft was passed around the proximal radius to recreate the annular ligament. We measured the total length of the graft, the length of graft required to approximate the posterior insertion of the annular ligament reconstruction, and the length of excess graft.
The average length of the superficial head of the brachialis muscle tendon available for use in reconstruction was 81 mm. The average length of tendon required to approximate the posterior anatomical insertion of the annular ligament was 69 mm. The average length of excess tendon was 12 mm. The tendon graft of the superficial head permitted potential annular ligament reconstruction in all specimens.
A distally based tendon graft reconstruction of the annular ligament of the elbow using the tendon of the superficial head of the brachialis muscle would be feasible in most patients, based on this anatomic study. Future studies should consider the biomechanical stability of this ligament reconstruction, choices of optimal posterior graft fixation, and clinical outcomes.
Incompetence of the annular ligament may cause persisting instability of the proximal radius requiring ligament reconstruction. The anatomic feasibility of using the distal tendon of the superficial head of the brachialis muscle as a distally based graft source is evaluated for annular ligament reconstruction.
评估肱肌浅层头较长的腱性附着作为肘环状韧带重建的局部移植物来源的潜在用途。
在24个未配对的新鲜冷冻尸体标本中，切取肱肌浅层头的肌腱作为带远端蒂的移植物。保留其在尺骨近端的腱性附着，将移植物绕过桡骨近端以重建环状韧带。我们测量了移植物的总长度、近似环状韧带重建后附着所需的移植物长度以及多余移植物的长度。
可用于重建的肱肌浅层头肌腱的平均长度为81毫米。近似环状韧带后解剖学附着所需的肌腱平均长度为69毫米。多余肌腱的平均长度为12毫米。肱肌浅层头的肌腱移植物在所有标本中都有可能重建环状韧带。
基于这项解剖学研究，对于大多数患者来说，使用肱肌浅层头肌腱进行带远端蒂的肌腱移植物重建肘环状韧带是可行的。未来的研究应考虑这种韧带重建的生物力学稳定性、最佳后方移植物固定方式的选择以及临床结果。
环状韧带功能不全可能导致桡骨近端持续不稳定，需要进行韧带重建。评估了使用肱肌浅层头远端肌腱作为带远端蒂移植物来源进行环状韧带重建的解剖学可行性。
