CAJ | 학술논문

目的探讨Essex-Lopresti损伤的生物力学机制,为诊治Essex-Lopresti损伤提供生物力学依据.方法取12具成人新鲜冰冻上肢标本予以处理,先将12具标本("完整状态组")分别在旋前位、旋后位及中立位三种状态下把标本夹持固定于MTS 858生物材料试验机上进行力学测试,恒定加载100 N的压力负荷,每种状态持续30 s后减载.随后将12具标本随机分为2组,6具切除桡骨头为"切头留膜组";另6具切断前臂骨间膜(interosseous membrane,IOM)中间腱性部分为"留头切膜组".每组按上述方法进行生物力学测试.最后将所有标本均切除桡骨头并切断IOM("切头切膜组")按上述方法进行生物力学测试.结果前臂旋转状态或单纯切断IOM对桡骨纵向位移无影响.单纯切除桡骨头或联合切断IOM和切除桡骨头增加了桡骨的纵向位移.前臂中立位时的桡骨刚度比前臂旋前位大,但比前臂旋后位小.单纯切断IOM对桡骨刚度没有影响,单纯切除桡骨头或联合切断IOM和切除桡骨头则会使桡骨刚度下降.结论桡骨头骨折合并IOM损伤可能是Essex-Lopresti损伤产生并发症的重要原因,其中桡骨头骨折是Essex-Lopresti损伤主要原因,而IOM损伤是次要原因.桡骨头切除后IOM是维持前臂纵向稳定的主要结构.
목적 탐토Essex-Lopresti손상적생물역학궤제,위진치Essex-Lopresti손상제공생물역학의거.방법 취12구성인신선빙동상지표본여이처리,선장12구표본("완정상태조")분별재선전위、선후위급중립위삼충상태하파표본협지고정우MTS 858생물재료시험궤상진행역학측시,항정가재100 N적압력부하,매충상태지속30 s후감재.수후장12구표본수궤분위2조,6구절제뇨골두위"절두류막조";령6구절단전비골간막(interosseous membrane,IOM)중간건성부분위"류두절막조".매조안상술방법진행생물역학측시.최후장소유표본균절제뇨골두병절단IOM("절두절막조")안상술방법진행생물역학측시.결과 전비선전상태혹단순절단IOM대뇨골종향위이무영향.단순절제뇨골두혹연합절단IOM화절제뇨골두증가료뇨골적종향위이.전비중립위시적뇨골강도비전비선전위대,단비전비선후위소.단순절단IOM대뇨골강도몰유영향,단순절제뇨골두혹연합절단IOM화절제뇨골두칙회사뇨골강도하강.결론 뇨골두골절합병IOM손상가능시Essex-Lopresti손상산생병발증적중요원인,기중뇨골두골절시Essex-Lopresti손상주요원인,이IOM손상시차요원인.뇨골두절제후IOM시유지전비종향은정적주요결구.
Objective To study the biomechanical mechanism of Essex-Lopresti injury, and provide biomechanical basis for diagnosis and treatment of Essex-Lopresti injury. Methods Twelve fresh frozen adult upper limbs were addressed. Firstly, 12 samples ("complete state group") were loaded 100 N of a compressive force lasting 30 seconds in pronation, supination and neutral position on the mechanical testing machine. Secondly, 12 specimens were randomly divided into 2 groups. In the group named resection of radial head, the radial head was removed and interosseous membrane (IOM)was intact. In the group named the section of interosseous membrane, IOM was cut off. Finally, the radial head were removed and IOM was cut off in all specimens. The group was named as resection of radial head and IOM. Each sample was tested according to the method as described. Results The forearm rotation or single excision of the IOM had no effect on radial longitudinal displacement. Simple radial head excision or resection of the IOM and the radial head increased the vertical displacement of the radius. The radial stiffness had a gradual decline in forearm supination, neutral position and pronation. Simple excision IOM has no effect on the radial stiffness. The radial stiffness had decreased under the condition of excision of radial head or resection of the IOM and the radial head. Conclusion These in vitro measurements validate that the radial head fracture with IOM injury may be important reason for complications of the Essex-Lopresti injury. Radial head fracture play a key role for Essex-Lopresti injury and the injury of IOM is secondary cause. IOM is responsible for maintaining the vertical stability of the forearm after radial head resection.