冠突骨折行桡骨小头切除对肘关节稳定性的实验研究.doc

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1、冠突骨折行桡骨小头切除对肘关节稳定性的实验研究作者：宋景仑，王鹏程，张奉琪【摘要】［目的］桡骨小头粉碎骨折时往往行桡骨小头切除术。本研究目的是分析桡骨小头粉碎骨折伴尺骨冠突骨折时行桡骨小头切除前后肘关节的稳定性。［方法］选取骨密度值相近的上肢标本20对，经X线片证实无风湿、结核、肿瘤、骨折、畸形等。剥离上肢所有的皮肤、肌肉和筋膜，完整保留肘关节囊、内外侧副韧带、环状韧带及尺、桡骨骨间膜。调制好的牙托粉与标本两端固定后，将标本伸直侧位自由放置于生物力学机，关节轴与水平面垂直，肱骨外髁向上，于肱骨外髁处垂直向下载荷，记录肘外翻位移。将标本竖直固定于生物力学机，尺桡骨向下，肘关节伸直位，做肘外

2、旋扭转，记录肘关节的转角。［结果］桡骨小头粉碎骨折伴冠突无骨折、Ⅰ型骨折、Ⅱ型骨折在桡骨小头切除后较切除前肘外翻位移及外旋角经统计学比较各组间并无显著性差异；伴冠突Ⅲ型骨折时在桡骨小头切除后较切除前肘外翻位移及外旋角显著增大。［结论］桡骨小头粉碎骨折伴冠突Ⅰ、Ⅱ型骨折行桡骨小头切除前后肘关节均稳定，可行桡骨小头切除术，Ⅲ型骨折不稳定，应修复桡骨小头或假体置换，并修复冠突及尺桡侧副韧带。【关键词】肘关节；桡骨小头；尺骨冠突；骨折；生物力　　Experimentalstudyoftheelbowjointstabilityontheexperimentalexcisionoftheradia

3、lheadinthecaseofcoronoidprocessfractures　　Abstract：［Objective］Todeterminetheelbowjointstabilityoftheradialheadcomminutedfracturewithvarioustypesofthecoronoidprocessfracturesafterexperimentalexcisionoftheradialhead.［Method］Twentypairsofembalmedanatomicspecimenepipodswhichhadsimilarbonedensityscann

4、edbyDEXAwereselected.Skin,musclesandfasciaewerestrippedwhilereservingthefullofarticularcapsule,MCLandLCL,ALandinterosseusmembrancebetweenUlnaandradius;Deformation,tumorandfracturewerenotfoundinallspecimens.Afterthebothendsofthespecimenwerefixedbythemodulateddentalbaseacrylicresinpowder.Specimenk

5、eepingaextensionlateralpositionwereplacedinthebothendsofthelevelsupportofthebiomechanicsmachinefreely.Thejointaxiswereverticaltohorizontalplane.Thehumeruslateralepicondylewasupandimposedverticallybythemachinewhiletheelboweversiondisplacementwasrecorded.Afterthespecimenwerefixedinthebiomechanicsm

6、achineverticallywhiletheulnaandradiusweredownandtheelbowjointwerestretched,the5elbowwasmadeexternalrotationandthecomeroftheelbowjointwasrecorded.［Result］Theelboweversiondisplacementandextemalrotationcomerwerenotstatisticallysignificantdifferenceamongthecoronoidprocessnofracture,thetypeⅠfracturean

7、dthetypeⅡfracturebeforeandafterexperimentalexcisionoftheradialhead,buttheelboweversiondisplacementandextemalrotationcomerofthetypeⅢfractureweresignificantlyincreased.［Conclusion］Undertheconditionoftheradialheadcomminut