Department of Orthopedics, Biomechanics Laboratory, Mayo Clinic, Rochester, MN, USA; Department of Orthopedic Surgery, Chuncheon Sacred Heart Hospital, Hallym University Medical College, Chuncheon, Republic of Korea.
Department of Orthopedics, Biomechanics Laboratory, Mayo Clinic, Rochester, MN, USA.
J Shoulder Elbow Surg. 2019 Jan;28(1):170-177. doi: 10.1016/j.jse.2018.07.016. Epub 2018 Oct 15.
The interosseous membrane (IOM) and distal radioulnar joint (DRUJ) provide axial stability to the forearm. Our hypothesis was that injury to these structures alters force transmission through the elbow.
A custom-designed apparatus that applies axial loads from the wrist to the elbow was used to test 10 cadaveric upper limbs under the following simulated conditions (1) intact, (2) DRUJ injury, (3) IOM injury, or (4) IOM + DRUJ injury. IOM injury was simulated by osteotomies of the IOM attachment to the radius, and DRUJ injury was simulated by distal ulnar oblique osteotomy. We applied 160 N of axial force during cyclic and functional range of forearm rotation (40 pronation/40 supination), and force, contact pressure, and contact area through the elbow joint were measured simultaneously.
The force across the radiocapitellar joint was significantly higher in the IOM + DRUJ injury and the IOM injury groups than in the intact and DRUJ injury groups. The mean force across the radiocapitellar joint was not significantly different between the intact and DRUJ injury groups or between the IOM + DRUJ injury and the IOM injury groups. Forces across the ulnohumeral joint showed an inverse pattern to those in the radiocapitellar joint.
These findings suggest that injury to the IOM contributes more to the disruption of the normal distribution of axial loads across the elbow than injury to the DRUJ.
骨间膜（IOM）和下尺桡关节（DRUJ）为前臂提供轴向稳定性。我们的假设是，这些结构的损伤会改变通过肘部的力传递。
使用一种定制的装置，从手腕向肘部施加轴向载荷，测试了 10 个尸体上肢在以下模拟条件下的情况：（1）完整，（2）DRUJ 损伤，（3）IOM 损伤，或（4）IOM+DRUJ 损伤。IOM 损伤通过 IOM 与桡骨的附着处的截骨术模拟，DRUJ 损伤通过尺骨远端斜形截骨术模拟。我们在周期性和功能性前臂旋转范围内（40 度旋前/40 度旋后）施加 160 N 的轴向力，同时测量肘部的力、接触压力和接触面积。
在 IOM+DRUJ 损伤和 IOM 损伤组中，桡骨头关节的力明显高于完整组和 DRUJ 损伤组。桡骨头关节的平均力在完整组和 DRUJ 损伤组之间或 IOM+DRUJ 损伤组和 IOM 损伤组之间没有显著差异。尺骨头关节的力呈现与桡骨头关节相反的模式。
这些发现表明，与 DRUJ 损伤相比，IOM 损伤对肘部轴向负荷正常分布的破坏作用更大。
