University of Turin - Medical School, Turin, Italy.
University of Turin - Medical School, Turin, Italy.
J Hand Surg Am. 2021 Mar;46(3):245.e1-245.e7. doi: 10.1016/j.jhsa.2020.09.013. Epub 2020 Dec 9.
The lateral ulnar collateral ligament (LUCL) is considered to be the portion of the lateral collateral ligament playing the most important stabilizing role. Iatrogenic forms of posterolateral rotatory instability have been described. The Kocher approach is a popular approach to the lateral side of the elbow. The aim of this study was to describe the relationship between the LUCL and the Kocher interval.
The Kocher interval was identified and marked in 20 cadavers. The LUCL was identified and the distance between the LUCL insertion on the tubercle of the cresta supinatoris and the Kocher interval was calculated (TK distance). This distance was considered 0 if the Kocher interval was directly above the tubercle, as a positive value if it was anterior to the tubercle, and as a negative value if it was posterior. Finally, the Kocher interval was sharply opened, and elbow stability was tested using the posterolateral rotatory drawer test.
A discrete LUCL was identified in 16 specimens. The mean TK distance was -2.3 ± 4.4 mm (range, -11 to +10). The median TK distance was -3 mm. The posterolateral rotatory drawer test was positive for subluxation after the sharp incision of the Kocher interval in 15 specimens. The median TK distance was significantly higher in the stable group (+2 mm) than in the unstable group (-3 mm).
The LUCL often lies beneath the Kocher interval and is at risk during the Kocher approach.
Iatrogenic forms of posterolateral rotatory instability could result from this approach.
尺侧副韧带（ULCL）被认为是在外侧副韧带中发挥最重要稳定作用的部分。已经描述了医源性后外侧旋转不稳定的形式。科赫（Kocher）入路是一种常用于肘部外侧的入路。本研究的目的是描述 ULCL 与科赫间隔（Kocher interval）之间的关系。
在 20 具尸体中确定并标记科赫间隔。识别 ULCL，并计算 ULCL 在旋后嵴上结节上的插入点与科赫间隔之间的距离（TK 距离）。如果科赫间隔直接位于结节上方，则 TK 距离为 0，如果位于结节前方，则为正值，如果位于结节后方，则为负值。最后，锐性打开科赫间隔，并使用后外侧旋转抽屉试验测试肘部稳定性。
16 个标本中均识别出离散的 ULCL。平均 TK 距离为-2.3±4.4mm（范围，-11 至+10）。中位数 TK 距离为-3mm。在 15 个标本中，在锐性切开科赫间隔后，后外侧旋转抽屉试验出现半脱位，阳性。稳定组的中位数 TK 距离（+2mm）明显高于不稳定组（-3mm）。
ULCL 通常位于科赫间隔下方，在科赫入路时存在风险。
这种入路可能导致医源性后外侧旋转不稳定。
