侧副韧带在肘关节后内侧旋转不稳定中的作用课件

单击此处编辑母版标题样式,单击此处编辑母版文本样式,第二级,第三级,第四级,第五级,*,*,侧副初带在肘关节后内侧旋转,不稳定中的作用,侧副韧带在肘关节后内侧旋转不稳定中的作用侧副初带在肘关节后内侧旋转,不稳定中的作用,美国明尼苏达州罗切斯特梅奥诊所骨科外科,意大利都灵大学医学院骨伤科,韩国釜山英杰大学 haeundae(海云台)Paik医院骨科,ORIGINAL ARTICLE,Role of the lateral collateral ligament in,posteromedial rotatory instability of the elbow,Enrico Bellato,MD,b Youngbok Kim,MD,James S Fitzsimmons,BSc,Alexander W.Hooke,MA,Lawrence J Berglund,BS,Daniel R.Bachman,MD.,Shawn W.oDriscoll,PhD,MD,*,Departmen:of Orthopedic Surger,Mayo Clinic,I,Deparment of Orthopedics and Tratmatoog Uni,Turin Merical School,Turin,itaiy,Departmen of Onhepedic Surger Haeundae Paik,al.Inje Uniersity,Busan,Republic of Korea,ral ligament(LCL and posterior bundle t,(PMCL)tears.We hypothesized that the LCL tear is required for elbow subluxation/joint incongruity and,研究背景,肘部后内侧旋转不稳(PMR庄主要由前内侧冠状骨折伴外侧副切带(CL)和内侧副韧,带后束(PMCL)撕裂组成。研究者假设,肘关节半脱位/关节不协调需要LCL撕裂,受前内侧2型冠状突骨折和PMCL撕裂影响的肘关节接触压力不同于受PMR彯响的,付关节和完整的肘关节,Background:Posteromedial rotatory instability(PMri)of the elbow consists of an anteromedial,coro-noid fracture with lateral collateral ligament(LCL)and posterior bundle of the medial,collateral ligament(PMCL)tears.We hypothesized that the LCL tear is required for elbe,n/joint,ity and that an elbow affected by an anteromedial subtype 2 coronoid,fracture and a Pmcl tear exhibits contact pressures different from both an intact elbow and an,elbow affected by PMrI,美国明尼苏达州罗切斯特梅奥诊所骨科外科,意大利都灵大学医学院骨伤科,韩国釜山英杰大学 haeundae(海云台)Paik医院骨科,ORIGINAL ARTICLE,Role of the lateral collateral ligament in,posteromedial rotatory instability of the elbow,Enrico Bellato,MD,b Youngbok Kim,MD,James S Fitzsimmons,BSc,Alexander W.Hooke,MA,Lawrence J Berglund,BS,Daniel R.Bachman,MD.,Shawn W.oDriscoll,PhD,MD,*,Departmen:of Orthopedic Surger,Mayo Clinic,I,Deparment of Orthopedics and Tratmatoog Uni,Turin Merical School,Turin,itaiy,Departmen of Onhepedic Surger Haeundae Paik,al.Inje Uniersity,Busan,Republic of Korea,ral ligament(LCL and posterior bundle t,(PMCL)tears.We hypothesized that the LCL tear is required for elbow subluxation/joint incongruity and,研究背景,肘部后内侧旋转不稳(PMR庄主要由前内侧冠状骨折伴外侧副切带(CL)和内侧副韧,带后束(PMCL)撕裂组成。研究者假设,肘关节半脱位/关节不协调需要LCL撕裂,受前内侧2型冠状突骨折和PMCL撕裂影响的肘关节接触压力不同于受PMR彯响的,付关节和完整的肘关节,Background:Posteromedial rotatory instability(PMri)of the elbow consists of an anteromedial,coro-noid fracture with lateral collateral ligament(LCL)and posterior bundle of the medial,collateral ligament(PMCL)tears.We hypothesized that the LCL tear is required for elbe,n/joint,ity and that an elbow affected by an anteromedial subtype 2 coronoid,fracture and a Pmcl tear exhibits contact pressures different from both an intact elbow and an,elbow affected by PMrI,Background:Posteromedial dalry instabi lity PMRD)of the elbow consists of an anteromedial cg-,材料与方法:利用自行设计的,noid fracture with Lateral olla aral ligament(LCL)and postenor bundle o the medial collateral ligamant,PMCL)Rear.We hypothesized thal the LCL tear is required far elbow sublet ation je int incongruity and,模拟以肉负荷、被动弯曲肘关,that an elbow accad by an antemedial subtype 2 coronoid fracture and a PMCL tear chi bits contact,pressures diferent from bath an intact el bow and an ebow aftaxtal by PMRI,节090、测量关节接触压,Materials and methods:Six cada cric claws were tested under gravity varus stress tsing acistom-made,mahime designed to aimmlate muscle lds and to passively flex the alb w fmm I te 9p and,力的机械装置,对6具尸体肘,m灿1M(:na部在重力内翻应力下进行测试,were tested.The highest ynes ef man cooma presure were usad for the comparison amang the 3 graups.,Results:Neither subluxaion nor jint incongruity was cbserved in the COR+FMCL-elbow.The ddi,在对完整标本完整肘关节)进,inn of an LCL dta hInant consistently cau sad subluxation and pint inomngnity:Mean contact pressures,were higher in th:COR+FMCL-ebow compured wih the INTACI-elbow(P.03)but lower than in the,行检测后,对前内侧亚型冠状,PMRI-elbow(P10,旋后旋前旋转140,或有关节炎或畸,形的放射学征象。将皮肤和皮下脂肪从肱骨中移至肘关节远端5cm处。二头肌、肱,和三头肌腹肌在保留肌腱的同时,用 Krackow锁紧缝针,用36公斤(80磅编织的,钓丝线做好准备。保留了屈旋肌和旋后肌的肱骨起源为了方便压力传感器的放置,前囊被切除,保留侧支或环状韧带。任何软骨侵蚀到软骨下骨的标本都被排除在,外,没有丟弃正常关节接触的浅层侵蚀的标本。任何韧带功能不全的标本通过后,侧旋转抽屉试验或韧带直接显示后发现都被排除在外。然后用聚氨酯树脂将标,本的近端放置在一个平行于其长轴的圆柱形金属套筒中,将标本固定并加载到测试,器上。在尺骨裸露点的顶端迸进行横鹰嘴截骨术。,肱骨由轮子中心的卡盘固定,可,旋转以控制肱骨旋转90。二头,肌、肱肌和三头肌肌腱连接到气,动活塞上,模拟肌肉负荷。从这,些肌腱线通过滑轮(在图中灰色,滑轮的位置,以模拟生理方向,的拉力。固定在尺骨远端的条,线,穿过一个滑轮(白色滑轮),该滑轮与校准的电位器相连,以,检测屈角,图1),用于测试式肘关节在肱骨内旋转不同程度时被动,弯曲0至90的情况。二头肌、肱肌和肱三头肌肌腱,连接到气动活塞,以欖拟肌肉负荷,以提供动态关节,稳定性;负荷分别为25、25和50N分别施加于肱,头肌、肱肌和肱三头肌肌腱),3肌腱之间的力比为,1:1:24。每个滑轮与关节线和肱骨轴之间的距离,被设定,以模拟距关节线255cm的肌腱的生理位置,肱肌、肱二头肌和三头肌滑车分别位于距肱骨轴2,35和2厘米处。在眩骨内旋转90时测试时关节,通过将编织的涤纶线拉过前臂的运动范围,被动地、,连续地弯曲0到90,以避免任问手动外力的稳定或,分散效果。当肱骨内部旋转时,通常由前臂假定是通,过避免手腕或前臂的任何扭力来维持的。角度数据是,Patentiometer,使用连到电位器的滑轮(1中的白色滑轮)炇集的。,并与Tek扫描和屈曲角度数据采集同步(用摄像初对准,肘关节内侧,Testing protocol,检验规程为了減减少关节表面与传感器之间的摩擦,在传感器插入后,在接头上加,入2m矿物油。在用生理盐水进行试验时,关节表面和肌腱经常受潮。标本分3次,连续测试。为了防止数据损坏,每个样本使用了2个传感器:第一次和第二次试验,使用了一个传感器,第三次试验使用了另一个传感器。在每个测试之间,传感器被,移除并再次校准。如图2所示,进行孤立的前内侧2型冠状骨折,PMCL从鹰嘴后缘,切割至尺骨非关节裸露区,如先前描述的(OR PMCL前内侧亚型冠状骨折伴内侧,副韧带撕裂。第三,用LCL撕裂完成PMR!损伤PMR时部的模拟。这种方法可以,模拟急性PMRI肘部的病理变化,其中lCL从肱骨髁上撕脱,并在肌腱下收缩。,LCL通过前囊切开术显露,并从伸肌的下表面解剖肌腱,切在连接线上,不影响肌,腱