Schmidt Christopher C, Brown Brandon T, Williams Benjamin G, Rubright James H, Schmidt Daniel L, Pic Andrew C, Nakashian Michael R, Schimoler Patrick J, Miller Mark Carl
Orthopaedic Specialists-UPMC, Department of Orthopaedic Surgery, University of Pittsburgh School of Medicine, 9104 Babcock Boulevard, Suite 5113, Pittsburgh, PA 15237. E-mail address:
Department of Mechanical Engineering, University of Pittsburgh, 609 Benedum Hall, 3700 O'Hara Street, Pittsburgh, PA 15213.
J Bone Joint Surg Am. 2015 Dec 16;97(24):2014-23. doi: 10.2106/JBJS.N.01221.
The radial tuberosity contributes to the biceps supination moment arm and the elbow flexion moment. The purpose of our study was to compare the impact of a cortical bone trough versus an anatomic repair on measurements of the forearm supination moment arm and elbow flexion force efficiency. Our hypothesis was that a trough repair would decrease the tuberosity height, the native biceps supination moment arm, and elbow flexion force efficiency compared with an anatomic repair.
The isometric supination moment arm and elbow flexion force efficiency were measured in ten matched pairs of cadaveric upper limbs. After testing, the geometry of the proximal aspect of the radius was reconstructed with use of stereophotogrammetry. All of the repair sites were three-dimensionally reconstructed to quantify the disturbance of the trough on native anatomy. The tuberosity distance was defined as the distance between the central axis of the radius and the centroid of the respective repair site.
Specimens with a trough repair had a 27% lower supination moment arm at 60° of supination (p = 0.036). There were no differences found for pronation or neutral forearm positioning (p > 0.235). Flexion force efficiency was not significantly different between the trough and anatomic repair groups. The average tuberosity distance was 11.0 ± 2.1 mm for the anatomic repairs and 8.3 ± 1.4 mm for the trough repairs (p = 0.003). The percentage of distance lost due to the trough was 25%. Furthermore, the supination moment arm in the supinated position was significantly correlated with the tuberosity distance.
The trough technique resulted in a significant decrease (p = 0.036) in the moment arm of a 60° supinated forearm and a significant reduction (p = 0.003) in radial tuberosity height. The loss of the supination moment arm was correlated with the decrease in tuberosity height, providing evidence that the radial protuberance acts as a mechanical cam.
The anterior protuberance of the radial tuberosity functions as a supination cam; therefore, consideration should be given to preserve its topographical anatomy during a distal biceps repair.
桡骨粗隆对肱二头肌旋后力臂和肘关节屈曲力矩有影响。本研究的目的是比较皮质骨槽修复与解剖修复对前臂旋后力臂测量值和肘关节屈曲力效率的影响。我们的假设是，与解剖修复相比，槽修复会降低粗隆高度、肱二头肌固有旋后力臂和肘关节屈曲力效率。
在十对匹配的尸体上肢中测量等长旋后力臂和肘关节屈曲力效率。测试后，使用立体摄影测量法重建桡骨近端的几何形状。所有修复部位均进行三维重建，以量化骨槽对正常解剖结构的干扰。粗隆距离定义为桡骨中轴线与相应修复部位质心之间的距离。
采用骨槽修复的标本在旋后60°时旋后力臂降低27%（p = 0.036）。在旋前或前臂中立位时未发现差异（p > 0.235）。骨槽修复组和解剖修复组之间的屈曲力效率无显著差异。解剖修复的平均粗隆距离为11.0 ± 2.1 mm，骨槽修复为8.3 ± 1.4 mm（p = 0.003）。由于骨槽导致的距离损失百分比为25%。此外，旋后位的旋后力臂与粗隆距离显著相关。
骨槽技术导致旋后60°前臂的力臂显著降低（p = 0.036），桡骨粗隆高度显著降低（p = 0.003）。旋后力臂的损失与粗隆高度的降低相关，这表明桡骨粗隆起到了机械凸轮的作用。
桡骨粗隆的前突起到旋后凸轮的作用；因此，在肱二头肌远端修复过程中应考虑保留其局部解剖结构。
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