中国骨与关节杂志
中國骨與關節雜誌
중국골여관절잡지
Chinese Journal of Bone and Joint
2015年
10期
785-789
,共5页
肘关节%侧副韧带%创伤和损伤%修复外科手术%生物力学%恐怖三联征
肘關節%側副韌帶%創傷和損傷%脩複外科手術%生物力學%恐怖三聯徵
주관절%측부인대%창상화손상%수복외과수술%생물역학%공포삼련정
Elbow joint%Collateral ligaments%Wounds and injuries%Reconstructive surgical procedures%Biomechanics%Terrible triad
目的：通过测量肘关节内侧副韧带( medial collateral ligament，MCL )完整状态、肘关节恐怖三联征模型中损伤状态及重建后肘关节的生物力学指标，探讨 MCL 对肘关节稳定性的影响，评价修复 MCL 的疗效。方法选用6具新鲜冰冻男性成人肘关节标本制成肘关节恐怖三联征模型。采用数字散斑相关法，分别在1.5 N·m 的外翻及内旋力矩下，在肘关节0°、30°、60°、90°屈曲时测量：(1)肘关节完整状态(对照组)下肱尺关节的外翻及内旋角度；(2)恐怖三联征模型下，固定冠突、桡骨头，修复外侧副韧带，不修复 MCL (修复组1)时肱尺关节的外翻及内旋角度；(3)恐怖三联征模型下，固定冠突、桡骨头，修复外侧副韧带，修复 MCL (修复组2)时肱尺关节的外翻及内旋角度。实验数据采用 SPSS 17.0统计软件进行分析。结果对照组0°、30°、60°、90°屈曲角度下的外翻角度为(3.3±0.7)°、(3.4±1.3)°、(3.6±0.9)°、(3.7±1.5)°；修复组1的外翻角度为(4.7±1.7)°、(5.0±1.9)°、(6.1±2.0)°、(6.9±2.2)°；修复组2的外翻角度为(3.9±0.9)°、(4.1±0.8)°、(4.2±1.2)°、(4.4±1.6)°、(4.2±1.2)°。对照组0°、30°、60°、90°屈曲角度下的内旋角度为(6.0±2.0)°、(5.8±1.8)°、(6.2±1.2)°、(8.3±1.1)°；修复组1的内旋角度为(6.5±1.9)°、(7.1±2.2)°、(8.2±1.8)°、(12.3±2.1)°；修复组2的内旋角度为(6.2±1.2)°、(6.0±1.6)°、(6.5±1.3)°、(8.4±1.5)°。肘关节恐怖三联征损伤中 MCL 修复后(修复组2)与 MCL 修复前(修复组1)比较，肘关节外翻及内旋稳定性明显增大，差异有统计学意义(P＜0.05)，MCL 修复后(修复组2)与完整状态下的肘关节(对照组)比较，外翻及内旋稳定性组间差异无统计学意义( P＞0.05)。结论恐怖三联征中 MCL 损伤后会导致肘关节外翻及内旋不稳定，临床上对肘关节恐怖三联征患者修复 MCL 可能会改善肘关节的稳定性。
目的：通過測量肘關節內側副韌帶( medial collateral ligament，MCL )完整狀態、肘關節恐怖三聯徵模型中損傷狀態及重建後肘關節的生物力學指標，探討 MCL 對肘關節穩定性的影響，評價脩複 MCL 的療效。方法選用6具新鮮冰凍男性成人肘關節標本製成肘關節恐怖三聯徵模型。採用數字散斑相關法，分彆在1.5 N·m 的外翻及內鏇力矩下，在肘關節0°、30°、60°、90°屈麯時測量：(1)肘關節完整狀態(對照組)下肱呎關節的外翻及內鏇角度；(2)恐怖三聯徵模型下，固定冠突、橈骨頭，脩複外側副韌帶，不脩複 MCL (脩複組1)時肱呎關節的外翻及內鏇角度；(3)恐怖三聯徵模型下，固定冠突、橈骨頭，脩複外側副韌帶，脩複 MCL (脩複組2)時肱呎關節的外翻及內鏇角度。實驗數據採用 SPSS 17.0統計軟件進行分析。結果對照組0°、30°、60°、90°屈麯角度下的外翻角度為(3.3±0.7)°、(3.4±1.3)°、(3.6±0.9)°、(3.7±1.5)°；脩複組1的外翻角度為(4.7±1.7)°、(5.0±1.9)°、(6.1±2.0)°、(6.9±2.2)°；脩複組2的外翻角度為(3.9±0.9)°、(4.1±0.8)°、(4.2±1.2)°、(4.4±1.6)°、(4.2±1.2)°。對照組0°、30°、60°、90°屈麯角度下的內鏇角度為(6.0±2.0)°、(5.8±1.8)°、(6.2±1.2)°、(8.3±1.1)°；脩複組1的內鏇角度為(6.5±1.9)°、(7.1±2.2)°、(8.2±1.8)°、(12.3±2.1)°；脩複組2的內鏇角度為(6.2±1.2)°、(6.0±1.6)°、(6.5±1.3)°、(8.4±1.5)°。肘關節恐怖三聯徵損傷中 MCL 脩複後(脩複組2)與 MCL 脩複前(脩複組1)比較，肘關節外翻及內鏇穩定性明顯增大，差異有統計學意義(P＜0.05)，MCL 脩複後(脩複組2)與完整狀態下的肘關節(對照組)比較，外翻及內鏇穩定性組間差異無統計學意義( P＞0.05)。結論恐怖三聯徵中 MCL 損傷後會導緻肘關節外翻及內鏇不穩定，臨床上對肘關節恐怖三聯徵患者脩複 MCL 可能會改善肘關節的穩定性。
목적：통과측량주관절내측부인대( medial collateral ligament，MCL )완정상태、주관절공포삼련정모형중손상상태급중건후주관절적생물역학지표，탐토 MCL 대주관절은정성적영향，평개수복 MCL 적료효。방법선용6구신선빙동남성성인주관절표본제성주관절공포삼련정모형。채용수자산반상관법，분별재1.5 N·m 적외번급내선력구하，재주관절0°、30°、60°、90°굴곡시측량：(1)주관절완정상태(대조조)하굉척관절적외번급내선각도；(2)공포삼련정모형하，고정관돌、뇨골두，수복외측부인대，불수복 MCL (수복조1)시굉척관절적외번급내선각도；(3)공포삼련정모형하，고정관돌、뇨골두，수복외측부인대，수복 MCL (수복조2)시굉척관절적외번급내선각도。실험수거채용 SPSS 17.0통계연건진행분석。결과대조조0°、30°、60°、90°굴곡각도하적외번각도위(3.3±0.7)°、(3.4±1.3)°、(3.6±0.9)°、(3.7±1.5)°；수복조1적외번각도위(4.7±1.7)°、(5.0±1.9)°、(6.1±2.0)°、(6.9±2.2)°；수복조2적외번각도위(3.9±0.9)°、(4.1±0.8)°、(4.2±1.2)°、(4.4±1.6)°、(4.2±1.2)°。대조조0°、30°、60°、90°굴곡각도하적내선각도위(6.0±2.0)°、(5.8±1.8)°、(6.2±1.2)°、(8.3±1.1)°；수복조1적내선각도위(6.5±1.9)°、(7.1±2.2)°、(8.2±1.8)°、(12.3±2.1)°；수복조2적내선각도위(6.2±1.2)°、(6.0±1.6)°、(6.5±1.3)°、(8.4±1.5)°。주관절공포삼련정손상중 MCL 수복후(수복조2)여 MCL 수복전(수복조1)비교，주관절외번급내선은정성명현증대，차이유통계학의의(P＜0.05)，MCL 수복후(수복조2)여완정상태하적주관절(대조조)비교，외번급내선은정성조간차이무통계학의의( P＞0.05)。결론공포삼련정중 MCL 손상후회도치주관절외번급내선불은정，림상상대주관절공포삼련정환자수복 MCL 가능회개선주관절적은정성。
Objective To investigate the effects of medial collateral ligament ( MCL ) on the stability of the elbow and to evaluate the results after the reconstruction of MCL by measuring the biomechanical indexes of the elbow with or without terrible triad injuries before and after the reconstruction.Methods The elbow specimens from 6 fresh-frozen male adults were adopted to establish an elbow model with terrible triad injuries. The digital speckle correlation method ( DSCM ) was used. The following angles were measured when the valgus and internal rotation moments were 1.5 N·m and the elbow lfexion angles were 0°, 30°, 60° and 90° respectively. ( 1 ) The valgus and internal rotation angles of the ulnohumeral joint of the normal elbow were measured ( control group ). ( 2 ) In the elbow model with terrible triad injuries, the valgus and internal rotation angles of the ulnohumeral joint were measured with the coronoid process and radial head ifxed and lateral collateral ligament ( LCL ) but not MCL repaired ( repair group 1 ). ( 3 ) In the elbow model with terrible triad injuries, the valgus and internal rotation angles of the ulnohumeral joint were measured with the coronoid process and radial head ifxed and LCL and MCL repaired ( repair group 2 ). All the experimental data were statistically analyzed by using SPSS 17.0 software.Results The valgus angles were ( 3.3±0.7 ) °, ( 3.4±1.3 ) °, ( 3.6±0.9 ) ° and ( 3.7±1.5 ) ° in the control group when the elbow lfexion angles were 0°, 30°, 60° and 90° respectively, which were ( 4.7±1.7 ) °, ( 5.0±1.9 ) °, ( 6.1±2.0 ) ° and ( 6.9±2.2 ) ° in the repair group 1 and ( 3.9±0.9 ) °, ( 4.1±0.8 ) °, ( 4.2±1.2 ) ° and ( 4.4±1.6 ) ° in the repair group 2. The internal rotation angles were ( 6.0±2.0 ) °, ( 5.8±1.8 ) °, ( 6.2±1.2 ) ° and ( 8.3±1.1 ) ° in the control group when the elbow lfexion angles were 0°, 30°, 60° and 90° respectively, which were ( 6.5±1.9 ) °, ( 7.1±2.2 ) °, ( 8.2±1.8 ) ° and ( 12.3±2.1 ) ° in the repair group 1 and ( 6.2±1.2 ) °, ( 6.0±1.6 ) °, ( 6.5±1.3 ) ° and ( 8.4±1.5 ) ° in the repair group 2. The stability of valgus and internal rotation of the elbow was signiifcantly increased after the repair of MCL, and the differences between the repair group 1 and 2 were statistically signiifcant (P<0.05 ). The differences were not statistically signiifcant in the stability of valgus and internal rotation of the elbow when the repair group 2 and the control group were compared (P>0.05 ).Conclusions MCL injuries will lead to instability of the valgus and internal rotation of the elbow in the patients with terrible triad injuries. The elbow stability may be improved by repairing the MCL in treatment of terrible triad of the elbow.
