Camp Christopher L, Klinger Craig E, Lazaro Lionel E, Villa Jordan C, van der List Jelle P, Altchek David W, Lorich Dean G, Dines Joshua S
Sports Medicine and Shoulder Service, Hospital for Special Surgery, New York, New York, USA.
Department of Orthopedic Surgery and Sports Medicine, Mayo Clinic, Rochester, Minnesota, USA.
Orthop J Sports Med. 2018 Apr 2;6(4):2325967118763153. doi: 10.1177/2325967118763153. eCollection 2018 Apr.
Although vascularity plays a critical role in healing after ulnar collateral ligament (UCL) reconstruction, intraosseous blood flow to the medial epicondyle (ME) and sublime tubercle remains undefined.
To quantify vascular disruption caused by tunnel drilling with the modified Jobe and docking techniques for UCL reconstruction.
Controlled laboratory study.
Eight matched pairs (16 specimens) of fresh-frozen cadaveric upper extremities were randomized to 1 of 2 study groups: docking technique or modified Jobe technique. One elbow in each pair underwent tunnel drilling by the assigned technique, while the contralateral elbow served as a control. Pregadolinium and postgadolinium magnetic resonance imaging were performed to quantify intraosseous vascularity within the ME, trochlea, and proximal ulna. Three-dimensional computed tomography (CT) and gross dissection were performed to assess terminal vessel integrity.
Ulnar tunnel drilling had minimal impact on vascularity of the proximal ulna, with maintenance of >95% blood flow for each technique. Perfusion in the ME was reduced 14% (to 86% of baseline) for the docking technique and 60% (to 40% of baseline) for the modified Jobe technique (mean difference, 46%; = .029). Three-dimensional CT and gross dissection revealed increased disruption of small perforating vessels of the posterior aspect of the ME for the modified Jobe technique.
Although tunnel drilling in the sublime tubercle appears to have a minimal effect on intraosseous vascularity of the proximal ulna, both the docking and modified Jobe techniques reduce flow in the ME. This reduction was 4 times greater for the modified Jobe technique, and these findings have important implications for UCL reconstruction surgery.
As the rate of revision UCL reconstructions continues to rise, investigation into causes for failure of primary surgery is needed. One potential cause is poor tendon-to-bone healing due to inadequate vascularity. This study quantifies the amount of vascular insult that is incurred in the ME during UCL reconstruction. While vascular insult is only one of many factors that affects the surgical success rate, surgeons performing this procedure should be mindful of this potential for vascular disruption.
尽管血管生成在尺侧副韧带（UCL）重建后的愈合过程中起着关键作用，但内侧髁（ME）和小结节的骨内血流情况仍不明确。
量化采用改良乔布技术和对接技术进行UCL重建时，隧道钻孔所导致的血管破坏情况。
对照实验室研究。
将8对（16个标本）新鲜冷冻的尸体上肢随机分为2个研究组中的1组：对接技术组或改良乔布技术组。每对中的一个肘关节采用指定技术进行隧道钻孔，而对侧肘关节作为对照。在注射钆对比剂前后进行磁共振成像，以量化ME、滑车和尺骨近端内的骨内血管生成情况。进行三维计算机断层扫描（CT）和大体解剖以评估终末血管的完整性。
尺骨隧道钻孔对尺骨近端的血管生成影响极小，两种技术的血流均维持在>95%。对接技术使ME的灌注减少14%（降至基线的86%），改良乔布技术使ME的灌注减少60%（降至基线的40%）（平均差异为46%；P = 0.029）。三维CT和大体解剖显示，改良乔布技术使ME后侧的小穿支血管破坏增加。
尽管在小结节处进行隧道钻孔似乎对尺骨近端的骨内血管生成影响极小，但对接技术和改良乔布技术均会减少ME内的血流。改良乔布技术导致的血流减少幅度是对接技术的4倍，这些发现对UCL重建手术具有重要意义。
随着UCL翻修重建率持续上升，需要对初次手术失败的原因进行调查。一个潜在原因是由于血管生成不足导致肌腱与骨愈合不良。本研究量化了UCL重建过程中ME内发生的血管损伤量。虽然血管损伤只是影响手术成功率的众多因素之一，但实施该手术的外科医生应注意这种血管破坏的可能性。
