冠突骨折行橈骨小頭切除對肘關(guān)節(jié)穩(wěn)定性的實驗研究

1、冠突骨折行橈骨小頭切除對肘關(guān)節(jié)穩(wěn)定性的實驗研究         08-06-27 16:08:00     編輯：studa20                  作者：宋景侖，王鵬程，張奉琪【摘要】  目的橈骨小頭粉碎骨折時往往行橈骨小頭切除術(shù)。本研究目的是分析橈骨小頭粉碎骨折伴尺骨冠突骨折時行橈

2、骨小頭切除前后肘關(guān)節(jié)的穩(wěn)定性。方法選取骨密度值相近的上肢標本20對，經(jīng)X線片證實無風濕、結(jié)核、腫瘤、骨折、畸形等。剝離上肢所有的皮膚、肌肉和筋膜，完整保留肘關(guān)節(jié)囊、內(nèi)外側(cè)副韌帶、環(huán)狀韌帶及尺、橈骨骨間膜。調(diào)制好的牙托粉與標本兩端固定后，將標本伸直側(cè)位自由放置于生物力學機，關(guān)節(jié)軸與水平面垂直，肱骨外髁向上，于肱骨外髁處垂直向下載荷，記錄肘外翻位移。將標本豎直固定于生物力學機，尺橈骨向下，肘關(guān)節(jié)伸直位，做肘外旋扭轉(zhuǎn)，記錄肘關(guān)節(jié)的轉(zhuǎn)角。結(jié)果橈骨小頭粉碎骨折伴冠突無骨折、型骨折、型骨折在橈骨小頭切除后較切除前肘外翻位移及外旋角經(jīng)統(tǒng)計學比較各組間并無顯著性差異；伴冠突型骨折時在橈骨小頭切除后較切除前肘外

3、翻位移及外旋角顯著增大。結(jié)論橈骨小頭粉碎骨折伴冠突、型骨折行橈骨小頭切除前后肘關(guān)節(jié)均穩(wěn)定，可行橈骨小頭切除術(shù)，型骨折不穩(wěn)定，應修復橈骨小頭或假體置換，并修復冠突及尺橈側(cè)副韌帶。 【關(guān)鍵詞】  肘關(guān)節(jié)；橈骨小頭；尺骨冠突；骨折；生物力Experimental study of the elbow joint stability on the experimental excision of the radial head in the case of coronoid process fractures    Abstract：ObjectiveTo de

4、termine the elbow joint stability of the radial head comminuted fracture with various types of the coronoid process fractures after experimental excision of the radial head. MethodTwenty pairs of embalmed anatomic specimen epipods which had similar bone density scanned by DEXA were selected. Skin, m

5、uscles and fasciae were stripped while reserving the full of articular capsule, MCL and LCL, AL and interosseus membrance between Ulna and radius; Deformation, tumor and fracture were not found in all specimens. After the both ends of the specimen were fixed by the modulated dental base acrylic resi

6、n powder. Specimen keeping a extensionlateral position were placed in the both ends of the level support of the biomechanics machine freely. The joint axis were vertical to horizontal plane. The humerus lateral epicondyle was up and imposed vertically by the machine while the elbow eversion displace

7、ment was recorded . After the specimen were fixed in the biomechanics machine vertically while the ulna and radius were down and the elbow joint were stretched, the elbow was made external rotation and the comer of the elbow joint was recorded.ResultThe elbow eversion displacement and extemalrotatio

8、n comer were not statistically significant difference among the coronoid process no fracture, the type fracture and the type fracture before and after experimental excision of the radial head, but the elbow eversion displacement and extemalrotation comer of the type fracture were significantly incre

9、ased.ConclusionUnder the condition of the radial head comminuted fracture with coronoid process fractures: with the type fracture and the type coronoid process fracture, the elbows are stable before and after experimental excision of the radial head, thus  the radial head excision could be advo

10、cated; with the type coronoid process fracture the elbows are unsteady, thus the radial head fracture or the prosthetic replacement should be suggested combined with treatment of coronoid process fracture, MCL and LCL injuries    Key words：radial head；elbow joint；fracture；  biome

11、chanics橈骨小頭粉碎骨折時往往行橈骨小頭切除術(shù)。作者曾對尺骨冠突骨折及合并橈骨小頭粉碎骨折時肘關(guān)節(jié)穩(wěn)定性1做過討論，本研究主要是對橈骨小頭粉碎骨折伴尺骨冠突骨折時行橈骨小頭切除前后肘關(guān)節(jié)的穩(wěn)定性進行分析。1材料與方法1.1 材料與設備    成年防腐尸體標本20具(男12具，女8具，骨密度值相近)；自凝牙托粉(型)2500g，自凝牙托水2500 ml。CSS44020萬能力學試驗機；CR X線機；雙能X線骨密度儀。1.2  實驗方法1.2.1  標本的制備 選取骨密度值相近的上肢標本40個，經(jīng)X線片證實無風濕、結(jié)核、腫瘤、骨折、

12、畸形等。剝離上肢所有的皮膚、肌肉和筋膜，完整保留肘關(guān)節(jié)囊、內(nèi)外側(cè)副韌帶、環(huán)狀韌帶及尺、橈骨間膜，近端距肘關(guān)節(jié)25 cm左右處鋸斷肱骨，遠端自掌腕關(guān)節(jié)處離斷解脫，保留腕骨與標本相連。1.2.2骨折類型的制備 尺骨冠突骨折均按Regan和Morrey的分類，型冠突尖骨折、型冠突骨折受累<50和型冠突骨折受累>50。橈骨小頭粉碎骨折是按Mason對橈骨小頭骨折分類的延伸，即型骨折屬粉碎骨折，骨鑿錘擊制成。橈骨小頭切除是在環(huán)狀韌帶上緣平面。1.2.3 實驗步驟 將40個標本隨機分成4組，每組10個，用調(diào)制好的牙托粉將標本兩端插入模具中固定，尺橈骨成中立位。        將標本伸直側(cè)位自由放置于生物力學機，關(guān)節(jié)軸與水平面垂直，肱骨外髁向上，于肱骨外髁處以10 mmmin速度垂直向下載荷。由于加壓至40 N時力位移曲線呈平直或下滑趨勢，故記錄載荷至35 N肘外翻位移。將標本豎直固定于生物力學機，尺橈骨向下，肘關(guān)節(jié)伸直位，以10°min的速度做肘外旋扭轉(zhuǎn)。由于扭矩在8 Nm時扭矩轉(zhuǎn)角曲線呈平直或下滑趨勢，故記錄7.5 Nm時肘關(guān)節(jié)的轉(zhuǎn)角(圖1、2)。    按表1、2所示，標本按照橈骨小頭粉碎骨折，冠突無骨折、型冠