锚钉联合骨道技术重建肘关节尺侧副韧带前束的生物力学研究

Biomechanical study on the reconstruction of anterior bundle of ulnar collateral ligament of elbow joint using suture anchor combined with bone tunnel technique

目的探讨肘关节尺侧副韧带（ulnar collateral ligament,UCL）前束在完整、断裂、重建三种状态时的肘外翻稳定性,评价锚钉联合骨道重建技术的有效性。方法选用8具新鲜成人尸体上肢制成肘关节骨-韧带模型,均先后模拟成UCL前束完整、断裂及锚钉联合骨道技术重建前束3种状态,测量各状态下肘关节在屈曲0°、30°、60°、90°、120°时的生物力学指标,包括外翻松弛度、肱桡关节接触面积、肱桡关节内压强;根据前束的不同状态分为完整组、断裂组、重建组,每组8具标本,将得出的数据进行统计学分析。结果组内比较,各组在屈肘0°时的生物力学指标与其余角度比较,差异具有统计学意义（P〈0.05）;组间比较,各组在0°时的生物力学指标比较,差异无统计学意义（P〉0.05）;组间比较,除0°以外的其余角度,完整组与断裂组、重建组与断裂组的生物力学指标差异有统计学意义（P〈0.05）,完整组与重建组的生物力学指标差异无统计学意义（P〉0.05）。结论 UCL前束是维持肘关节外翻稳定性的重要结构。肘关节在伸直位时较屈曲位处于相对稳定状态。锚钉联合骨道技术重建UCL前束不仅能恢复肘外翻稳定性,而且还具有与正常肘关节同等优良的生物力学特性。

Objective To explore the valgus stability of the elbow joint when the anterior bundle of ulnar collateral ligament（UCL） in three states of complete, fracture and reconstruction, and to evaluate the effectiveness of suture anchor combined with bone tunnel technique. Methods 8 fresh adult upper limb cadavers were adopted to establish samples of the bone-ligament of the elbow joint, and the anterior bundle of UCL of each sample was simulated as three states of intact, fracture and reconstruction, then the biomechanical indexes of the elbow joint at 0°, 30°, 60°, 90° and 120°, including valgus laxity, contact area and pressure in the humeroradial joint. The samples were divided into 3 groups according to the different state of the anterior bundle of UCL： the intact group, the fracture group, and the reconstruction group. There were 8 cases in every group. The data were obtained and statistic analysis was made. Results In each group, the biomechanical indexes of each group at 0° were significantly different when those under（P〈0.05）;among the three groups,there was no statistical difference in the biomechanical indexes of each group at 0 °（P〉0.05）, whereas significant difference would be found at the other angles between the intact and fracture groups and the fracture and reconstruction groups（P〈0.05）. Conclusion The anterior bundle of UCL is an important structure to maintain the valgus stability of the elbow joint. The elbow joint at the straight position is relatively stable compared with the flexion position. The elbow joint after reconstruction of anterior bundle of UCL using suture anchor combined with bone tunnel technique not only has sufficient stability, but also has the same excellent biomechanical properties as the normal elbow.