Lühmann Paul, Kremer Thomas, Siemers Frank, Rein Susanne
Department of Plastic and Hand Surgery with Burn Unit, Hospital Sankt Georg, Leipzig, Germany.
Department of Plastic and Hand Surgery with Burn Unit, Trauma Center Bergmannstrost, Halle, Germany.
Clin Anat. 2022 Nov;35(8):1070-1084. doi: 10.1002/ca.23913. Epub 2022 May 18.
This study aimed to compare the histomorphology of the elbow capsule and its ligaments to gain a better understanding of the clinically relevant biomechanical stabilization. Eleven human elbows were dissected including the joint capsule with its anterior (AJC) and posterior (PJC) parts, the annular ligament (AL), the radial collateral ligament (RCL) and the ulnar collateral ligament with its anterior (AUCL), posterior (PUCL) and transverse (TUCL) parts. Hematoxylin-Eosin and Elastica van Gieson as conventional histology stainings were applied to determine collagenous and elastic fiber arrangements in transmission and polarization light microscopy. The radial collateral ligament and the anterior part of the ulnar collateral ligament showed significantly more densely packed parallel fiber arrangement than the anterior joint capsule, the posterior joint capsule, and the posterior part of the ulnar collateral ligament (p < 0.02, respectively). The PUCL had significantly more mixed tight and loose parallel arrangements than the PJC, the annular ligament, the RCL, the AUCL and the transverse part of the ulnar collateral ligamentp < 0.02, respectively), while the PJC showed significantly more interlaced mixed tight and loose fiber arrangement than the AL, the RCL and the AUCL (p < 0.003, respectively). The AJC had a significantly higher amount of elastic fibers as compared to the AL, the RCL, the AUCL and the TUCL in fascicular regions (p < 0.04, respectively), while the AUCL had significantly lesser elastic fibers than the AJC and the PJC (p < 0.004, respectively). The densely packed parallel fiber arrangement and few elastic fibers of the AUCL, RCL, and AL indicate a strong biomechanically stabilizing function. The fiber arrangement of the PUCL and the TUCL with few elastic fibers support the medial elbow stabilization. Crimping and elastic fibers provide the viscoelasticity of the joint capsule.
本研究旨在比较肘关节囊及其韧带的组织形态学，以更好地理解临床相关的生物力学稳定性。解剖了11个成人肘关节，包括关节囊及其前部（AJC）和后部（PJC）、环状韧带（AL）、桡侧副韧带（RCL）以及尺侧副韧带及其前部（AUCL）、后部（PUCL）和横部（TUCL）。采用苏木精-伊红染色和弹性纤维染色作为传统组织学染色方法，在透射光和偏振光显微镜下确定胶原纤维和弹性纤维的排列。桡侧副韧带和尺侧副韧带前部的平行纤维排列明显比关节囊前部、关节囊后部和尺侧副韧带后部紧密（p值分别<0.02）。与PJC、环状韧带、RCL、AUCL和尺侧副韧带横部相比，PUCL的紧密和平行排列混合更为明显（p值分别<0.02），而PJC的紧密和疏松纤维交织排列比AL、RCL和AUCL更为明显（p值分别<0.003）。在束状区域，AJC的弹性纤维数量明显多于AL、RCL、AUCL和TUCL（p值分别<0.04），而AUCL的弹性纤维数量明显少于AJC和PJC（p值分别<0.004）。AUCL、RCL和AL紧密排列的平行纤维和较少的弹性纤维表明其具有强大的生物力学稳定功能。弹性纤维较少的PUCL和TUCL的纤维排列有助于维持肘关节内侧的稳定性。卷曲和弹性纤维赋予关节囊粘弹性。
