The Steadman Clinic, Vail, Colorado, USA.
The Steadman Philippon Research Institute, Vail, Colorado, USA.
Am J Sports Med. 2019 Apr;47(5):1117-1123. doi: 10.1177/0363546519831693. Epub 2019 Mar 21.
The vascular supply of the ulnar collateral ligament (UCL) is unknown. Previous studies reported varying success in return-to-play rates after nonoperative management of partial UCL tears and suggested a varying healing capacity as possibly related to the location of the UCL injury.
To analyze the macroscopic vascular anatomy of the UCL of the elbow.
Descriptive laboratory study.
Eighteen fresh-frozen male cadaveric elbows from 9 donors were sharply dissected 15 cm proximal to the medial epicondyle. Sixty milliliters of India ink was injected through the brachial artery of each elbow. Arms were then frozen at -10°C, radial side down, in 15° to 20° of elbow flexion. A band saw was used to section the frozen elbows into 5-mm coronal or sagittal sections. Sections were cleared for visualization with the modified Spalteholz technique. Images of the specimens were taken, and qualitative description of UCL vascularity was undertaken.
The authors consistently found a dense blood supply to the proximal UCL, while the distal UCL was hypovascular. They also observed a possible osseous contribution to the proximal UCL from the medial epicondyle in addition to an artery from the flexor/pronator musculature that consistently appeared to provide vascularity to the proximal UCL. The degree of vascular penetration from proximal to distal in the UCL ranged from 39% to 68% of the overall UCL length, with a 49% mean length of vascular penetration of the UCL.
This study found a difference in the vascular supply of the UCL. The proximal UCL was well vascularized, while the distal UCL was hypovascular. This difference in vascular supply may be a factor in the differential healing capacities of the UCL based on the location of injury.
An improved understanding of the macroscopic vascular supply of the UCL may aid in the clinical management of partial UCL tears and suggests an indication for these treatments with respect to location of UCL injuries.
尺侧副韧带（UCL）的血管供应尚不清楚。先前的研究报告称，非手术治疗 UCL 部分撕裂的患者在重返赛场方面的成功率各不相同，并认为愈合能力也不同，这可能与 UCL 损伤的位置有关。
分析肘部 UCL 的大体血管解剖结构。
描述性实验室研究。
对来自 9 名供体的 18 个新鲜冷冻的男性尸体肘部进行解剖，从内侧上髁近端 15cm 处进行锐性解剖。在每个肘部的肱动脉内注射 60ml 印度墨水。手臂然后在-10°C 下冷冻，桡侧朝下，肘部弯曲 15°至 20°。使用带锯将冷冻的肘部切成 5mm 的冠状或矢状切片。使用改良的 Spalteholz 技术对切片进行清除以进行可视化。对标本进行拍照，并对 UCL 的血管分布进行定性描述。
作者发现 UCL 近端有密集的血液供应，而 UCL 远端则血管较少。他们还观察到内侧上髁可能为 UCL 近端提供了骨质贡献，以及来自屈肌/旋前肌的动脉，该动脉似乎始终为 UCL 近端提供血液供应。在 UCL 内从近端到远端的血管穿透程度为 UCL 总长度的 39%至 68%，UCL 的血管穿透长度平均为 49%。
本研究发现 UCL 的血管供应存在差异。UCL 近端的血管丰富，而 UCL 远端的血管较少。这种血管供应的差异可能是 UCL 基于损伤位置的不同愈合能力的一个因素。
对 UCL 大体血管供应的进一步了解可能有助于 UCL 部分撕裂的临床治疗，并提示这些治疗方法与 UCL 损伤的位置有关。
