内侧副韧带修补与冠状突骨折固定对“恐怖三联征”肘关节稳定性影响的三维有限元分析研究
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上海市浦东新区公利医院

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Three dimensional finite element analysis of the effect on the stability of the "Terrible Triad" using medial collateral ligament repair and coronal process fracture fixation.
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Shanghai Gongli Hospital

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    摘要:

    目的 探讨内侧副韧带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 选用28岁成年健康男性志愿者,进行肘关节CT、MRI扫描得到相关数据,通过计算机软件,建立肘关节实体模型。制作三种肘关节模型:模型A:正常模型。模型B:修补冠状突骨折块,不修补内侧副韧带。模型C:修补内侧副韧带,不修补冠状突骨折块,并且对其分别施加纵向载荷,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 三个模型的位移分布云图和应力分布云图相当,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。各模型之间的最大位移与最大应力无统计学差异(P>0.05)。 结论 肘关节恐怖三联征稳定性重建时,外侧结构(桡骨小头、肱骨小头、桡侧副韧带等)至关重要,在外侧柱稳定的情况下,修复内侧副韧带与修复固定尺骨冠状突骨折块效果相似,在生物力学研究中无统计学差异。这也说明,当修复尺骨冠状突困难或固定不确切时,修补内侧副韧带可以替代修补尺骨冠状突,达到相似的力学稳定作用。

    Abstract:

    Object: To investigate the effect of medial collateral ligament repair and coronal process fracture fixation on the stability of the “Terrible Triad”. Methods: CT and MRI scans of elbow joints were performed from one healthy 28-year-old male volunteer. Make three elbow models: Model A: normal model. Model B: repair of coronal process fractures without repair of medial collateral ligament. Model C: repair of the medial collateral ligament without repair of the coronal process fracture block. Longitudinal loads were applied to analyze the displacement and stress distribution of the elbow joint. It would be compared of the stability of three models with various working conditions. Results: The nephograms of displacement distribution and stress distribution of the three models were similar. The maximum displacement and maximum stress of the articular surface were located at the ulna pulley notch, the minimum displacement was located at the coronal process and it’s medial side. The minimum stress was located at the lower lateral side of the coronal process. There was no statistical difference in the maximum displacement and stress among the models (P>0.05). Conclusion: The lateral structure is very important in the stability of the “horrible triad”. When the lateral column is stable, it is similar in the effect of repairing the medial collateral ligament and fixing the fracture block of ulna coronal process. This also indicates that when repairing the coronoid process of ulna is difficult or imprecise, repairing the medial collateral ligament can replace repairing the coronoid process of ulna.

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  • 收稿日期:2019-08-08
  • 最后修改日期:2019-11-26
  • 录用日期:2019-12-03
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