应用生物力学方法探讨桡骨小头切除术后晚期并发症的原因

Biomechanical Analysis of the Cause of the Late Complications after Excision of Radial Capitulum

自１９７８年，共施行健骨头切除术３７例。２７例获２年以上随访。肘外翻畸形，肘关节慢性不稳定，桡骨干上移和下尺桡关节脱位是主要并发症。作者用２０只新鲜上肢标本进行生物力学实验，发现肘关节内侧副韧带损伤，骨间膜撕裂伤和下尺桡关节脱位是引起或加重并发症的主要原因。其中内侧副韧带损伤是最重要的原因。同时，临床上也以桡骨头损伤合并内侧副韧带损伤多见。作者强调：桡骨头切除时，应考虑上述三种软组织损伤是否存在及其对预后的影响；桡骨头切除在青少年患者应视为禁忌；桡骨头切除应作为改善前臂功能的最后选择。

Excisions of radial capitula have been performed on 37 cases since 1978. 27 cases out of them have been followed-up for 2 years, the principal complications are cubitus valgus, chronic instability of elbow joint, upward shafting of the diaphysis of radius, and dislocation of distal radioulnar joint. In order to find out the causes of these complications, the biomechanical experiment was made on 20 specimens of fresh upper limbs. It was found that the excision of medial collateral ligament, the laceration of interosseous membrane, and the dislocation of distal radioulnar joint are the principal causes for inducing or exacerbating these complications. The most important one among them is the injury of medial col- lateral ligament. Clinically, the fracture of radial capitulum is often complicated with the injury of this ligament. It is emphasized that the excision of radial capitulum should be the last selection for improving the function of joint, whether the above mentioned three kinds of soft tissue injuries are existed or not and their influence upon the prognosis should be considered before operation. and the excision of radial capitulum should be avoided in juvenile patients.