肘关节内翻-后内侧旋转不稳定的系统生物力学和临床研究

Varus posteromedial rotational instability of elbow has be recognized in recent years, it is named according to the injury mechanism. By inversion, internal rotation and axial stress,the lateral collateral ligament is injured, then the anteriomedial facet of the coronoid process is fractured by impacted with medial side of trochlea, radiocapitellar space widened, associated with the ulnar-trochlear subluxation. ..This unstable fracture pattern may show only subtle joint incongruity and may be missed, leading to rapid development of arthrosis and elbow varus deformity. The injury is not uncommon clinically, but short of knowledgement and reports in the literatures, by now the mechanism and biomechanics of this injury is still not clear. So misdiagnosis and missing rate is very high in China, which caused severe complications...We were often difficult to decide operation or nonoperation according the extent of injury. By cadavar anatomic study and biomechanical experiments, we intend to reveal the role of ligaments and bony structures in this injury pattern, understand the mechanism of injury. According to this, we will design a controlled experiment to evaluate the different treatment methods, which will be profit to clinical application...This study will provide the theoretical basis about the injury mechanisms and treating methods to guide the clinical diagnosis and treatment. It also will improve the awareness and level of diagnosis and treatment for this elbow injury and disorders.

"肘关节内翻-后内侧旋转不稳定"是指受到内翻、内旋和轴向应力时，引起冠状突前内侧面骨折、外侧副韧带损伤、外侧肱桡关节间隙增宽，肱尺关节半脱位。.这是最近几年才提出的一种骨折类型，可仅表现为轻度的关节不匹配，易漏诊，很快会引起关节退变和肘关节内翻畸形等。临床上该损伤并不少见，但由于认识时间短，国内外相关的文献报道非常少，对其受伤机制及相关的生物力学认识不充分，漏诊率非常高，而对于何种程度的损伤可保守治疗或需要手术以及手术的方法尚不明确。.针对以上多方面的不足，本项目拟通过尸体解剖和生物力学实验结合临床研究，明确该损伤时所涉及的韧带和骨性结构及其损伤程度，揭示其损伤机制，并对其治疗方法进行对照研究，为临床诊疗提出理想的治疗方案。.通过本研究，可完善这一新的损伤类型的理论基础，从而指导临床治疗，提高对该疾患的认识和诊疗水平。

"肘关节内翻-后内侧旋转不稳定"是最近几年才提出的一种骨折类型，可仅表现为轻度的关节不匹配，易漏诊，很快会引起关节退变和肘关节内翻畸形等。由于认识时间短，国内外相关的文献报道非常少，对其受伤机制及相关的生物力学认识不充分，漏诊率非常高。针对以上多方面的不足，本研究主要对肘关节内翻-后内侧旋转不稳定这一疾患进行了系统的生物力学研究，结合相关的临床研究，对冠状突前内侧面骨折的生物力学特性进行研究，对照研究不同内固定方法对前内侧面骨折固定的生物力学稳定性的差异。建立了肘关节内翻-后内侧旋转不稳定的系统生物力学模型，对冠状突前内侧面骨折的不同固定方式进行了系统的生物力学研究，分为A（单纯克氏针固定）、B（接骨板螺丝钉结合克氏针固定）、C（双头螺纹的Herbert螺钉固定）三组，采用生物力学实验机（MTS 810）进行试验，记录位移-力曲线，取位移2mm或内固定物失效时冠状突前内侧面受力为失效应力。失效或者位移2mm时受力平均值分别为：A组380.47±130.47 N，B组711.45±172.74 N，C组367.18±122.56 N。从结果发现，接骨板螺丝钉结合克氏针固定的方式明显优于单纯克氏针固定和双头螺纹的Herbert螺钉固定，而后两者没有统计学差异，从而从生物力学角度明确冠状突前内侧面骨折的最佳固定方式，为临床诊疗提出了理想的治疗方案，有助于指导临床治疗，提高对该疾患的认识和诊疗水平。