J. Hreha, D. V. Congiusta, I. H. Ahmed, M. M. Vosbikian, Department of Orthopaedic Surgery, Rutgers University, New Jersey Medical School, Newark, NJ, USA.
Clin Orthop Relat Res. 2020 Jan;478(1):136-141. doi: 10.1097/CORR.0000000000000999.
Rotation of the forearm is a result of the complex interaction among the radius, ulna, and interosseous membrane. Although the radius is recognized as curved, the ulna is generally thought of as a "straight bone." To better describe normal anatomy, which may lead to more successful anatomic fixation of forearm fractures, we aimed to apply a method of measuring the normal ulnar bow and determine the mean ulnar bow in adults.
QUESTIONS/PURPOSES: (1) To what degree is the ulna bowed in the coronal and sagittal planes in normal adult forearms? (2) To what degree is the radius bowed in the coronal plane in normal adult forearms?
Radiographs of the forearms of adults taken during a 1-year period were initially obtained retrospectively. These radiographs were performed for various reasons, including forearm pain and routine radiographic follow-up. Radiographs were excluded if evidence of a fracture or post-fracture fixation was found, if a patient had missing AP or lateral images, or if a suboptimal technique was used. The coronal and sagittal bow of the ulna was measured with a method adapted from previous studies that assessed radial bow using AP and lateral radiographs, respectively. Similar measurements were made in the coronal plane for the radius. All measurements were performed independently by the four authors. There was excellent interobserver reliability for ulnar bow in the coronal and sagittal planes (interclass correlation coefficient = 0.96 and 0.97, respectively) and for radial bow in the coronal plane (interclass correlation coefficient = 0.90).
The mean maximal coronal ulnar bow was 7 ± 2 mm and was located at 75% of the ulnar length, measured proximally to distally. The location of coronal bow was consistently distal to the radial bow location. The mean maximal sagittal ulnar bow was 6 ± 3 mm and was located at 39% of the ulnar length. The mean maximal coronal bow of the radius was 14 ± 2.0 mm and was 59% of the total length of the radius from proximal to distal.
The ulna is not a "straight bone," as is commonly thought, but rather has a bow in both the coronal and sagittal planes.
Knowledge of the standard ulnar bow may be pivotal to prevent malunion of the ulna during surgery. Future research using these data in preoperative planning may lead to changes in plate contouring and clinical outcomes in forearm fracture management.
前臂的旋转是桡骨、尺骨和骨间膜复杂相互作用的结果。虽然桡骨被认为是弯曲的，但尺骨通常被认为是“直骨”。为了更好地描述正常解剖结构，从而更成功地进行前臂骨折的解剖固定，我们旨在应用一种测量正常尺骨弓的方法，并确定成人的平均尺骨弓。
问题/目的：（1）成人正常前臂在冠状面和矢状面的尺骨弯曲程度是多少？（2）成人正常前臂在冠状面的桡骨弯曲程度是多少？
我们回顾性地获得了成人前臂在 1 年内拍摄的 X 光片。这些 X 光片是由于各种原因拍摄的，包括前臂疼痛和常规 X 光随访。如果发现骨折或骨折固定后存在证据、患者缺少前后位或侧位图像或使用了不适当的技术，则排除这些 X 光片。我们使用分别用于评估桡骨前后位和侧位 X 光片的弯曲度的改良方法来测量尺骨的冠状和矢状弯曲度。在冠状面也对桡骨进行了类似的测量。所有测量均由四位作者独立进行。尺骨冠状和矢状弯曲的观察者间可靠性极好（组内相关系数分别为 0.96 和 0.97），桡骨冠状弯曲的观察者间可靠性也很好（组内相关系数为 0.90）。
尺骨最大冠状弯曲度为 7 ± 2 毫米，位于尺骨长度的 75%处，从近端到远端测量。冠状弯曲的位置始终位于桡骨弯曲位置的远端。尺骨最大矢状弯曲度为 6 ± 3 毫米，位于尺骨长度的 39%处。桡骨最大冠状弯曲度为 14 ± 2.0 毫米，占桡骨从近端到远端全长的 59%。
尺骨不是通常认为的“直骨”，而是在冠状面和矢状面都有弯曲。
了解标准尺骨弓对于预防手术中尺骨愈合不良至关重要。在术前规划中使用这些数据的未来研究可能会导致改变钢板轮廓，并改善前臂骨折管理的临床结果。
