Field L D, Altchek D W
Mississippi Sports Medicine and Orthopaedic Center, Jackson, Mississippi 39202, USA.
Am J Sports Med. 1996 Mar-Apr;24(2):177-81. doi: 10.1177/036354659602400210.
Seven fresh-frozen cadaveric elbows were used to evaluate the extent to which the medial collateral ligament must be injured before arthroscopic evidence of valgus instability is seen, the amount of ulnohumeral joint opening that does occur after such an injury, and the elbow position that maximizes visualization of this opening. While visualizing the most medial aspect of the ulnohumeral joint arthroscopically through the anterolateral portal, we sequentially sectioned the medial collateral ligament complex until all of the medial ligamentous restraints were cut. A valgus load was applied after each incision, and the extent to which the ulnohumeral joint opened was measured. Ulnohumeral joint opening was not visualized in any specimen until complete sectioning of the anterior bundle was performed. After the anterior bundle was released, 1 or 2 mm of joint opening was present in all specimens. Complete release of the medial collateral ligament led to dramatic increases in medial joint opening in all seven specimens (4 to 10 mm). Varying the angle of elbow flexion from 15 degrees to 120 degrees revealed that visualization of the medial joint opening was best at 60 degrees to 75 degrees. Finally, forearm pronation increased ulnohumeral joint opening and supination decreased joint opening in all specimens. We found that the entire anterior bundle must be sectioned before measurable and reproducible medial joint opening can occur.
使用七个新鲜冷冻的尸体肘关节来评估在出现关节镜下外翻不稳定证据之前内侧副韧带必须损伤的程度、这种损伤后发生的尺肱关节开口量以及使该开口可视化最大化的肘关节位置。通过前外侧入路关节镜观察尺肱关节最内侧时，我们依次切断内侧副韧带复合体，直到所有内侧韧带约束都被切断。每次切开后施加外翻负荷，并测量尺肱关节开口的程度。在未完全切断前束之前，任何标本中均未观察到尺肱关节开口。在前束被松解后，所有标本中均出现了1或2毫米的关节开口。内侧副韧带的完全松解导致所有七个标本的内侧关节开口显著增加（4至10毫米）。将肘关节屈曲角度从15度改变到120度显示，在60度至75度时内侧关节开口的可视化效果最佳。最后，在所有标本中，前臂旋前增加了尺肱关节开口，旋后减少了关节开口。我们发现，在出现可测量且可重复的内侧关节开口之前，必须切断整个前束。
