Gutowski Christina J, Darvish Kurosh, Ilyas Asif M, Jones Christopher M
Orthopaedic Service, Memorial Sloan Kettering Cancer Center, New York, NY.
Department of Mechanical Engineering, Temple University, Philadelphia, PA.
J Hand Surg Am. 2017 Feb;42(2):87-95. doi: 10.1016/j.jhsa.2016.11.013. Epub 2016 Dec 20.
The interosseous ligament (IOL) is known to be an important longitudinal stabilizer of the forearm. We hypothesize that it may also contribute to transverse stability, with pronosupination tensioning of the radius relative to the ulna. Therefore, when injured, we predict the interosseous space should widen in the transverse plane, enough to be appreciable on plain radiographs. A measurable difference in interosseous space, comparing an injured with an uninjured forearm, can potentially be of diagnostic and clinical value.
Ten fresh-frozen cadaver arms (from 5 individuals) were radiographed in 6 different positions of forearm supination, first in an uninjured state and then with the IOL sectioned, both partially (central band only) and completely. The transverse interosseous distance was measured on radiographs using edge detection software and compared using analysis of variance and contrast analysis. The maximum range of pronosupination was also compared before and after injury, using a paired t test.
Average maximum supination increased from 84° to 106°, and pronation from 69° to 84°, after the IOL was sectioned completely. Sectioning of the IOL led to a statistically significant increase in the interosseous distance, a minimum of 2 mm, in all but one forearm position.
The IOL of the forearm plays an important role in providing transverse stability to the radius and ulna. When the IOL is sectioned, the forearm exhibits increased pronosupination range of motion. Radiographs of bilateral forearms taken in identical rotational position can reliably differentiate between an intact and torn IOL in cadavers.
The IOL's stabilizing role during forearm rotation suggests a novel strategy for diagnosing forearm IOL injury using comparative radiographic measurements.
骨间韧带（IOL）是已知的前臂重要纵向稳定结构。我们推测它可能也有助于横向稳定，随着桡骨相对于尺骨的旋前旋后而产生张力。因此，当IOL损伤时，我们预测骨间隙在横断面上会增宽，在普通X线片上足以被观察到。比较受伤前臂与未受伤前臂的骨间隙可测量差异，可能具有诊断和临床价值。
对10只新鲜冷冻尸体手臂（来自5名个体）在6个不同的前臂旋后位置进行X线摄影，首先在未受伤状态下，然后分别部分（仅中央束）和完全切断IOL后进行摄影。使用边缘检测软件在X线片上测量横向骨间隙，并采用方差分析和对比分析进行比较。还使用配对t检验比较损伤前后旋前旋后的最大范围。
完全切断IOL后，平均最大旋后角度从84°增加到106°，旋前角度从69°增加到84°。除一个前臂位置外，IOL切断导致所有位置的骨间隙在统计学上显著增加，至少增加2mm。
前臂IOL在为桡骨和尺骨提供横向稳定方面起重要作用。当IOL被切断时，前臂的旋前旋后活动范围增加。在相同旋转位置拍摄的双侧前臂X线片能够可靠地区分尸体中IOL完整和撕裂的情况。
IOL在前臂旋转过程中的稳定作用提示了一种利用对比X线测量诊断前臂IOL损伤的新策略。
