旋前圆肌肌腱重建骨间膜中央束对Essex—Lopresti损伤后前臂纵向稳定的作用

Effect of pronator teres tendon reconstructing the forearm interosseous membrane central band on restoring the longitudinal stability of forearm after Essex-Lopresti injury

目的 研究旋前圆肌肌腱转位重建骨间膜中央束在恢复Essex-Lopresti损伤中前臂纵向稳定中的效果.方法 10具新鲜成人前臂标本,各标本依次按桡骨头切除、桡骨头＋三角纤维软骨复合体（TFCC）切除、桡骨头＋TFCC＋骨间膜中央束切除、旋前圆肌肌腱转位重建中央束、单纯桡骨头置换、旋前圆肌肌腱转位＋桡骨头置换6个步骤进行试验.应用单因素重复测量数据的方差分析比较各步骤桡骨向近端移位5 mm时施加在标本两端的负荷差异,进而判断各步骤对前臂纵向稳定的恢复效果.结果 各个步骤中桡骨向近端移位5 mm时所需平均负荷差异均有统计学意义（P＜0.01）.使桡骨向近端移位5 mm时,旋前圆肌重建中央束所需负荷是骨间膜完整时的55.66%;旋前圆肌肌腱转位＋桡骨头置换时所需负荷是单纯旋前圆肌肌腱重建中央束时的599.31%,是桡骨头切除时的333.56%.结论 单纯旋前圆肌肌腱转位重建中央束不足以恢复Essex-Lopresti损伤后前臂纵向稳定性;旋前圆肌重建中央束结合金属桡骨头假体置换更有利于恢复前臂的纵向稳定性.

Objective To evaluate the effect of pronator teres tendon reconstructing the forearm interosseous membrane（IOM）central band on restoring the longitudinal stability of the forearm after Essex-Lopresti injury.Methods A total of ten fresh-frozen adult cadaveric forearms were loaded axially through the humeral and the distal radius.Each forearm was tested as following six steps：radial head excision,radial head plus excision of triangular fibrocartilage complex（TFCC）,radial head plus TFCC plus excision of IOM central band,reconstructing central band with pronator teres tendon,metallic radial head prosthesis replacement,central band reconstruction plus radial head prosthesis replacement.The difference of the load exerted to displace the radius to the proximal for 5 mm was compared at different steps by using single-factor analysis of variance.Then,the effect of each step on restoring the forearm longitudinal stability of the forearmwas evaluated.Results There was statistical difference upon load for the radial displacement to the proximal for 5 mm in all six steps,ie,（74.51±15.17）N,（49.23±6.14）N,（17.83±4.73）N,（27.40±3.56）N,（140.25±25.39）Nand（164.21±28.26）N,respectively（P〈0.01）.With migration of the radius to proximal for 5 mm,the load for pronator teres reconstruction was 55.66% of radial head plus TFCC,and the load for pronator teres reconstruction plus radial head prosthesis replacement was 559.31% of IOM reconstruction step and 333.56% of radial head excision.Conclusions Reconstruction of the central band with pronator teres tendon is insufficient to restore the longitudinal stability of the forearm after Essex-Lopresti injury.Reconstruction of the central band in combination with metallic radial head prosthesis replacement are beneficial to restoring the longitudinal stability of the forearm.