桡骨头骨折脱位中侧副韧带的生物力学意义。
Biomechanical significance of the collateral ligaments in transolecranon fracture-dislocations.
机构信息
Institute of Military Medicine and Epidemiology, Norwegian Armed Forces Joint Medical Services, Oslo, Norway; Division of Orthopaedic Surgery, Oslo University Hospital, Oslo, Norway; Department of Biomedical Engineering, The Steadman Philippon Research Institute, Vail, CO, USA.
Department of Biomedical Engineering, The Steadman Philippon Research Institute, Vail, CO, USA; Department of Trauma and Orthopedic Surgery, BG Trauma Center Ludwigshafen, Ludwigshafen, Germany.
出版信息
J Shoulder Elbow Surg. 2021 Jun;30(6):1245-1250. doi: 10.1016/j.jse.2020.09.010. Epub 2020 Sep 30.
BACKGROUND
It is widely accepted that transolecranon fracture-dislocations are not associated with collateral ligament disruption. The aim of the present study was to investigate the significance of the collateral ligaments in transolecranon fractures.
METHODS
Twenty cadaveric elbows with a mean age of 46.3 years were used. All soft tissue was dissected to the level of the capsule, leaving the anterior band of the medial collateral ligament (MCL) and lateral collateral ligament (LCL) intact. A standardized, oblique osteotomy starting from the distal margin of the cartilage bare area of the ulna was made. The elbows were loaded with an inferiorly directed force of 5 and 10 N in the intact, MCL cut, LCL cut, and both ligaments cut states. All measurements were recorded on lateral calibrated radiographs.
RESULTS
The mean inferior translation with intact ligaments (n = 20) when the humerus was loaded with 5 and 10 N was 1.52 mm (95% confidence interval [CI], 1.02-2.02) and 2.23 mm (95% CI, 1.61-2.85), respectively. When the LCL was cut first (n = 10), the inferior translation with 5 and 10 N load was 4.11 mm (95% CI, 0.95-7.26) and 4.82 mm (95% CI, 1.91-7.72), respectively. When the MCL was cut first (n = 10), the inferior translation when loaded with 5 and 10 N was 3.94 mm (95% CI, 0.796-7.08) and 5.68 mm (95% CI, 3.03-8.33), respectively. The inferior translation when loaded with 5 and 10 N and both ligaments cut was 15.65 mm (95% CI, 12.59-18.79) and 17.50 mm (95% CI, 14.86-20.13), respectively. There was a statistical difference between the intact and MCL cut first at 10 N and when both ligaments were cut at 5 and 10 N.
CONCLUSIONS
The findings suggest that collateral ligament disruption is a prerequisite for a transolecranon fracture-dislocation. An inferior translation of more than 3 mm suggests that at least one of the collateral ligaments is disrupted, and more than 7.5 mm indicates that both collateral ligaments are disrupted.
背景
人们普遍认为，经桡骨颈骨折脱位与侧副韧带断裂无关。本研究旨在探讨桡骨颈骨折中侧副韧带的意义。
方法
使用 20 具平均年龄为 46.3 岁的尸体肘部。所有软组织均解剖至囊层，保留内侧副韧带（MCL）和外侧副韧带（LCL）的前束。从尺骨软骨裸区的远端边缘开始，进行标准化的斜形截骨。在完整、MCL 切断、LCL 切断和两条韧带切断的状态下，将肘部向下施加 5N 和 10N 的向下力。所有测量值均记录在侧位校准 X 光片上。
结果
当肱骨分别加载 5N 和 10N 时，完整韧带的平均下位移（n=20）分别为 1.52mm（95%置信区间[CI]，1.02-2.02）和 2.23mm（95%CI，1.61-2.85）。当首先切断 LCL 时（n=10），分别在 5N 和 10N 加载时的下位移为 4.11mm（95%CI，0.95-7.26）和 4.82mm（95%CI，1.91-7.72）。当首先切断 MCL 时（n=10），分别在 5N 和 10N 加载时的下位移为 3.94mm（95%CI，0.796-7.08）和 5.68mm（95%CI，3.03-8.33）。在分别加载 5N 和 10N 以及两条韧带切断时，下位移分别为 15.65mm（95%CI，12.59-18.79）和 17.50mm（95%CI，14.86-20.13）。在 10N 时，与完整韧带相比，MCL 首先被切断，而在 5N 和 10N 时，两条韧带都被切断，这之间存在统计学差异。
结论
研究结果表明，侧副韧带断裂是经桡骨颈骨折脱位的前提。下位移超过 3mm 表明至少有一条侧副韧带断裂，超过 7.5mm 表明两条侧副韧带均断裂。
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