内侧副韧带修补与冠状突骨折固定对恐怖三联征肘关节稳定性的影响

Effects on Elbow Stability of the Terrible Triad Using Medial Collateral Ligament Repair and Ulnar Coronoid Process Fixation

目的探讨内侧副韧带(medial collateral ligament,MCL)修补与冠状突骨折固定(Regan-Morrey II型)对"恐怖三联征"肘关节稳定性的影响。方法选取1名28岁成年健康男性志愿者的肘关节CT、MRI数据,建立肘关节实体模型。制作3种肘关节模型。模型A:正常模型;模型B:修补冠状突骨折块,不修补MCL;模型C:修补MCL,不修补冠状突骨折块。并且对3种模型分别施加纵向载荷,分析各种工况条件下肘关节关节面的位移、应力分布,比较肘关节的稳定性。结果 3种模型的位移、应力分布类似,关节面最大位移和最大应力均位于尺骨滑车切迹处,最小位移分布在尺骨冠状突及冠状突偏内侧附近区域,而最小应力分布在尺骨冠状突下方偏外侧附近区域。各模型最大位移与最大应力无统计学差异(P> 0.05)。结论在外侧柱稳定的情况下,修复MCL与修复固定尺骨冠状突骨折块效果相似。

Objective To investigate the effect of medial collateral ligament( MCL) repair and coronoid process fracture fixation on stability of the Terrible Triad of the elbow.Methods CT and MRI scan images of elbow joints from one healthy 28-year-old male volunteer were used to establish three elbow models.Model A: normal model.Model B: repair of coronoid process fractures,without MCL repair.Model C: repair of MCL,without repair of ulnar coronoid processes.Longitudinal loads were applied on the three models to analyze the displacement and stress distributions of the elbow joint under different working conditions and compare the stability of the elbow joint.Results The displacement and stress distributions of the three models were similar.The maximum displacement and maximum stress of the articular surface were located at the ulna pulley notch,while the minimum displacement was located at the coronoid process and its medial side.The minimum stress was located at the lower lateral side of the coronoid process.There were no statistical differences in the maximum displacement and stress among the three models( P > 0.05).Conclusions When the lateral column is stable,the effect of repairing the MCL and fixing the fracture block of ulnar coronoid process is similar.