Hand Surgery P.C., Department of Orthopaedic Surgery, Newton-Wellesley Hospital, Tufts University School of Medicine, Boston, MA, USA.
Department of Orthopaedic Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA.
J Shoulder Elbow Surg. 2019 May;28(5):e150-e155. doi: 10.1016/j.jse.2018.10.028. Epub 2019 Feb 1.
This study's purpose was to provide a reproducible way for surgeons to intraoperatively assess the elbow's lateral ulnar collateral ligament origin and determine whether there is posterolateral rotatory instability (PLRI) despite an intact common extensor origin (CEO). We hypothesized that we could re-create clinically relevant disruption of lateral supporting structures despite an intact CEO and illustrate progressive elbow PLRI.
The relationship of the lateral capsule to the capitellum articular surface was noted in 8 cadaveric upper extremities. The lateral capsule and extensor origin were sequentially sectioned at 4 stages: intact, release to the lateral epicondyle, release of the posterior capsular insertion, and release of the CEO. Posterior and lateral translation of the radial head (RH) relative to the capitellum was measured with the forearm in extension and supination.
The average specimen age was 78.9 years. The lateral capsule originated within 1 to 2 mm of the capitellum articular surface. Lateral capsular sectioning to the 6-o'clock position of the lateral epicondyle created an unstable elbow with posterior and lateral RH translation. Sequential sectioning of the posterior capsular insertion created significant additional RH translation posteriorly (P < .05). With release of the capsule and the extensor origin, the elbow was grossly unstable.
The elbow's lateral capsuloligamentous complex plays an important role in preventing PLRI. Larger degrees of elbow laxity are associated with further peel back of the capsuloligamentous complex despite an intact CEO. The surgeon must retract the extensor origin intraoperatively to assess for lateral ulnar collateral ligament and/or lateral capsule disruption to prevent a missed case of PLRI.
本研究的目的是为外科医生提供一种可重现的方法，以便在术中评估肘部外侧尺侧副韧带起点，并确定是否存在尽管存在完整的共同伸肌起点（CEO）但仍存在后外侧旋转不稳定（PLRI）。我们假设尽管存在完整的 CEO，但我们可以重新创建临床上相关的外侧支撑结构的破坏，并说明肘部进行性 PLRI。
在 8 个尸体上肢中注意到外侧囊与肱骨小头关节面的关系。在 4 个阶段，连续地将外侧囊和伸肌起点切开：完整、向外侧髁切开、后囊插入物切开和 CEO 切开。在前臂伸展和旋后时，测量桡骨头（RH）相对于肱骨小头的后外侧平移。
平均标本年龄为 78.9 岁。外侧囊起源于肱骨小头关节面 1 至 2mm 范围内。将外侧囊切开至外侧髁的 6 点钟位置会导致肘部不稳定，出现 RH 后外侧平移。后囊插入物的连续切开会导致 RH 向后明显增加平移（P<.05）。当囊和伸肌起点被释放时，肘部明显不稳定。
肘部的外侧囊韧带复合体在防止 PLRI 中起重要作用。更大程度的肘部松弛与尽管存在完整的 CEO 但仍进一步剥离囊韧带复合体有关。外科医生必须在术中牵拉伸肌起点，以评估外侧尺侧副韧带和/或外侧囊的破坏情况，以防止漏诊 PLRI。
