尺骨鹰嘴部分切除对肘关节稳定性影响的研究

The Search for the Effect of Partial Olecranon Resection On Elbow Stability

目的探讨尺骨鹰嘴尖部截骨短缩对肘关节稳定性的影响。方法取10具20侧男性新鲜上肢标本,随机分为四组,每组5侧标本,即尺骨鹰嘴完整组、截骨3 mm组、截骨6 mm组、截骨9 mm组,截骨在尺骨鹰嘴尖部。每组分别在肘关节屈曲30°、60°、90°、120°时,前臂加1.96 Nm力矩的情况下,测量外翻位肘外翻角度和内侧副韧带前束长度及内翻位肘内翻角度和桡侧尺副韧带长度。结果尺骨鹰嘴尖部截骨时,于同一肘关节屈曲位,随着尺骨鹰嘴尖部截骨量增大,肘关节内侧副韧带前束的长度逐渐变长,外翻角逐渐增大,当截骨量大于3 mm上述变化差异显著,有统计学意义(P<0.05)。结论尺骨鹰嘴尖部截骨量超过3 mm时,肘关节出现不稳定。因此临床上当尺骨鹰嘴尖部严重粉碎性骨折片不超过3 mm时,可予以手术切除,对肘关节稳定性影响不大,否则应给予修复重建。而对于尺骨鹰嘴尖部后内侧骨赘,建议仅切除骨赘或切除范围不超过正常鹰嘴尖部3 mm。

Objective The olecranon process is osteotomized partly and shortened,explore its effect on the stability of the elbow joint. Methods 20 fresh cadaver were studied. Osteotomy are made at the olecranon process and divide into four groups .intact, 3-mm resection, 6-mm resection, 9-mm resection. Each group is at 30°、 60° 、 90°、120° of elbow flexion,and adding 1.96 Nm torque to forearm,the valgus angulation and the length of the anterior bundle of the medial collateral ligament are measured in the valgus test position,the varus angulation and the length of the lateral ulnar collateral ligament are measured in the varus test position. Results At the same angulation of elbow flexion, with the osteotomized bone increasing,results in stepwise increases in the length of the anterior bundle of the medial collateral ligament and the valgus angulation,especially making clear differences where the range is beyond 3 mm resection. Conclusion When the osteotomized bone at the tip of olecranon is beyond 3 mm,occurs the unsteadiness of the elbow. So concerning to the treatment of its comminuted fractures,if specula isn＇t beyond 3 mm,it can be cut ,otherwise should be constructed. When curing of the osteophytes of the postermedial aspect of the olecranon process ,we advises to only resect the osteophytes,or resect within 3-mm at the tip of olecranon.