前臂骨间膜的解剖及生物力学研究

An anatomical and biomechanical study of the forearm interosseous membrane

目的 探讨前臂骨间膜（interosseous membrane，IOM）的解剖及生物力学特性。方法 从10个新鲜冰冻上肢标本中取出尺桡骨连同骨间膜结构，测量腱性部分的长度、宽度及厚度。测量完毕后将骨间膜腱性部分同其尺桡骨附着端一并分离，将标本的桡骨近端及尺骨远端分别用牙托粉包埋固定，标本夹持固定于MTS858型生物材料试验机上。使用10000N力传感器进行测定，以50mm/min的速度拉伸骨间膜，直至骨间膜断裂。通过计算机采集数据描绘载荷一位移曲线，同时测定骨间膜的最大载荷和刚度。结果 （1）前臂骨间膜由三部分组成：中央腱性部分、两端膜性部分及背侧附属斜索。3个标本中未观察到背侧附属斜索。骨间膜在前臂中立位时伸展，在前臂旋前及旋后时弯曲。（2）6个标本发生骨间膜腱性部分撕裂，最大载荷为（1021．50±250．13）N，刚度为（138．24±24．29）N／mm，骨间膜的拉伸长度为（9．77±1．77）mm；4个标本在腱性部分撕裂之前发生尺骨固定端骨折，最大载荷为（744．40±109．85）N，刚度为（151．17±30．68）N／mm，骨间膜的拉伸长度为（6．51±0．51）mm。结论 前臂骨间膜是尺桡骨之间具有韧带性质的结构，对维持前臂的纵向稳定至关重要。其解剖学及生物力学数据可以作为评估前臂骨间膜重建方法的客观标准。

Objective To observe the anatomical and biomechanical properties of the forearm in terosseous membrane （IOM）, providing the scientific theoretical basis for the diagnosis and treatment of the IOM injury. Methods Ten radius-IOM-ulna structures （left for 5 and right for 5） were harvested from 5 fresh-frozen adult cadavers to measure the length, width and thickness of the tendinous part. Then the tendinous part with its radial and ulnar insertions were isolated, embedding the proximal part of the radius and the distal part of the ulna in commercially available dental base acrylic resin powder. The embedded specimens were mounted on MTS 858 testing machine using a 10 000 N load cell for all tensile tests. The specimens were tested at a displacement rate of 50 mm/min until failure. The load-displacement curve was described by the computer while the maximum load and stiffness were recorded. Results The IOM consisted of three components： the tendinous part, the membranous part, and the dorsal oblique accessory cord. The IOM was flat in the neutral position, while it flexed during the pronation and supination. Six specimens obtained the tear of tendinous portion at a maximum load of （1021.50±250.13） N. The stiffness was （138.24±24.29） N/ram with displacement to failure of （9.77±1.77） ram. Other 4 specimens failed by fracture through the ulnar fixed site before there was failure of the IOM at a maximum load of （744.40±109.85） N. The stiffness was （151.17±30.68） N/mm with displacement to failure of （6.51±0.51） ram. Conclusion The IOM has stiffness comparable to the ligament between the radius and the ulna and play an important role for the maintenance of longitudinal stability of the forearm. These results can provide objective criteria for the evaluation of reconstructive methods.