尺侧副韧带完整性对肘关节稳定性的影响及临床研究

Clinical study of effects of the integrity of ulnar collateral ligament on the stability of elbow joint

目的探讨尺侧副韧带与桡骨头在肘关节稳定中的作用以及评价手术修复尺侧副韧带后的外翻稳定性。方法取12侧尸体上肢标本,制成骨-韧带标本,建立尺侧副韧带(M C L)损伤伴有或不伴有桡骨头(R H)骨折的模型,并随机分成:完整肘关节组、M C L切断+R H完整组、R H切除+M C L切断组、R H切除组和M C L重建组。在肘关节屈曲0、30、60、90和120°时,测量前臂在施加2N m外翻力矩下的肘外翻松弛度。结果在肘关节不同屈曲角度,完整肘关节的外翻松弛度最小,R H切除时肘外翻松弛度增大,单纯M C L切断时肘外翻松弛度大于单纯R H切除(P<0.05),R H切除+M C L切断时肘外翻稳定性最差,M C L重建与完整M C L差异无显著性(P>0.05)。结论 M C L是对抗肘关节外翻不稳的主要结构,其次是R H。单纯R H骨折不能复位内固定时,R H切除是可行的;若合并M C L损伤时,可在有效修补M C L的同时作单纯R H切除,必要时行R H置换。

【Objective】 To study the effect of medial collateral ligament and radial head integrity on stability of elbow joint,and the clinical effect of surgical operation.【Methods】 The fracture models of the radial head（RH） accompanied with or without the injury of the ulnar collateral ligament（MCL） were established in 12 adult cadavers,which were dissected to establish 5 kinds of specimens with elbow joint and ligaments as follow： excision of the RH,release of the MCL and excision of the RH combined with release of the MCL,excision of the radial head and medial collateral ligament reconstruction.The valgus elbow laxity at 0,30,60,90 and 120 degrees of flexion was measured with 2.0-newton-meter valgus torque.【Results】 The least valgus laxity was seen in the intact state and its stability was the best.The laxity increased after resection of the RH.The laxity was more after release of the MCL than that after resection of the RH（P 0.05）.The greatest laxity was observed after resection of the RH combined with release of the MCL,so its stability was the worst.The laxity of the medial collateral ligament reconstruction was as much as that of the intact ligament（P 0.05）.【Conclusion】 The MCL is the primary valgus stabilizer of the elbow and the RH was a secondary constraint to resist valgus instability.The resection of the RH is feasible without the injury of other tissue when the fracture can not be replaced and fixed.When there is the injury of the MCL,the resection of the RH can also be performed after the ligament is repaired simultaneously and effectively,and prosthesis replacement is recommended if necessary.