Hackl Michael, Wegmann Kilian, Kahmann Stephanie L, Heinze Nicolai, Staat Manfred, Neiss Wolfram F, Scaal Martin, Müller Lars P
Center for Orthopedic and Trauma Surgery, University Medical Center of Cologne, Kerpener Straße 62, 50937, Cologne, Germany.
Cologne Center for Musculoskeletal Biomechanics, Medical Faculty, University of Cologne, Cologne, Germany.
Knee Surg Sports Traumatol Arthrosc. 2017 Jul;25(7):2280-2288. doi: 10.1007/s00167-017-4468-z. Epub 2017 Feb 25.
Shortening osteotomy of the proximal radius might represent a potential salvage procedure in symptomatic radiocapitellar osteoarthritis, which could decrease radiocapitellar load while preserving the native radial head. In an in-vitro biomechanical investigation, we sought to determine whether shortening osteotomy of the proximal radius (1) decreases the radiocapitellar joint pressure upon axial loading and (2) retains valgus stability of the elbow. In addition, the anatomic configuration of the lesser sigmoid notch was evaluated to assess possible contraindications.
Axial loading (0-400 N) and valgus torque (7.5 N m) over the full range of motion were applied to 14 fresh-frozen specimens before and after shortening osteotomy of the proximal radius by 2.5 mm. Radiocapitellar and ulnohumeral load distribution during axial compression was evaluated using a digital pressure mapping sensor. Valgus displacement was analyzed with a 3D camera system. The inclination angle (α) of the lesser sigmoid notch was assessed via 50 CT scans.
Up to axial loading of 250 N, shortening osteotomy caused a significant decrease in radiocapitellar contact pressures (p < 0.041). Valgus stability of specimens did not differ before and after shortening osteotomy (n.s.). The mean inclination angle (α) of the lesser sigmoid notch was 11.3° ± 6.3°. 46% had an inclination angle of ≤ 10° (type I). 46% had an inclination angle of 11°-20° (type II). In 8%, the inclination angle was >20° (type III).
Shortening osteotomy of the proximal radius can decrease radiocapitellar contact pressures during axial loading of up to 250 N. Primary valgus stability is not relevantly influenced by this procedure. In few patients, shortening osteotomy may cause radioulnar impingement of the radial head at the distal edge of the lesser sigmoid notch due to an inclination angle of >20°. Shortening osteotomy might be a promising treatment option to decrease pain levels in case of isolated radiocapitellar osteoarthritis.
对于有症状的桡骨头-肱骨小头骨关节炎，缩短桡骨近端截骨术可能是一种潜在的挽救手术，该手术可在保留天然桡骨头的同时降低桡骨头-肱骨小头的负荷。在一项体外生物力学研究中，我们试图确定桡骨近端缩短截骨术是否（1）在轴向加载时降低桡骨头-肱骨小头关节压力，以及（2）保持肘关节的外翻稳定性。此外，评估了小乙状切迹的解剖结构以评估可能的禁忌症。
在对14个新鲜冷冻标本进行桡骨近端缩短2.5mm截骨术之前和之后，在整个运动范围内施加轴向载荷（0 - 400N）和外翻扭矩（7.5N·m）。使用数字压力映射传感器评估轴向压缩过程中桡骨头-肱骨小头和尺骨-肱骨的负荷分布。用3D相机系统分析外翻位移。通过50例CT扫描评估小乙状切迹的倾斜角（α）。
在轴向载荷达到250N时，缩短截骨术导致桡骨头-肱骨小头接触压力显著降低（p < 0.041）。缩短截骨术前后标本的外翻稳定性无差异（无统计学意义）。小乙状切迹的平均倾斜角（α）为11.3°±6.3°。46%的倾斜角≤10°（I型）。46%的倾斜角为11° - 20°（II型）。8%的倾斜角>20°（III型）。
桡骨近端缩短截骨术可在轴向载荷高达250N时降低桡骨头-肱骨小头接触压力。该手术对原发性外翻稳定性无显著影响。在少数患者中，由于倾斜角>20°，缩短截骨术可能导致桡骨头在小乙状切迹远端边缘出现桡尺撞击。对于孤立性桡骨头-肱骨小头骨关节炎，缩短截骨术可能是一种有前景的减轻疼痛水平的治疗选择。
