摘要
目的目前国内尚未提出难治性网球肘主要病理改变是肱桡关节滑膜的嵌顿及难治性网球肘X线片征象深入研究的报道。为了验证上述观点的准确性与科学性,正确的指导临床治疗难治性网球肘提供理论依据,设计本课题,对肱桡关节的解剖结构及肱桡关节各个骨性角度的X线片进行观察、测量与分析。
方法通过选择经福尔马林溶液浸泡后成人尸体肘关节标本20副;
1.观察肱骨小头和桡骨小头的骨性关系.
2.观察肘关节副韧带的形态结构特点及大体观察肘关节不同屈曲角度时副韧带长度的变化。
3.观察肘关节关节囊和桡侧副韧带的形态以及起止点的位置
选取正常肱桡关节X线图片30张;普通型网球肘X线图片30张;难治性网球肘X线图片30张;
1.做桡骨小头内外侧连线的中点P与肱骨小头最外侧点A,线段AB与桡骨小头内外侧连线BC所成的角度α。也称为肱桡关节外侧开口角。
2.肱骨干中轴线HJ与由滑车及小头远端之间引一切线EF所交之角γ称为肱骨角
3.尺骨干中轴线G0与由滑车及小头远端之间引一切线EF所交之角β称为尺骨角
4.桡骨颈中轴线与桡骨中轴线所角之角称为颈干角∠Q
5.取肱骨小头最外侧A点,作垂直于桡骨小头内外侧连线BC交与D点,测量线段DE;也称为肱骨小头关节面外缘内移量。
6.桡骨颈纵轴延长线距肱骨小头最低点的垂直距离MN,称为头一颈距
结果桡侧副韧带与环状韧带在尺骨上的止点有两种类型:第一种桡侧副韧带的部分纤维汇入桡骨环状韧带的尺骨点,部分纤维单独止于稍远的尺骨上;第二种桡侧副韧带和桡骨环状韧带形成一宽的纤维止于尺骨上。肘关节屈曲超过90°时,桡侧副韧带紧张度明显增加,但与桡骨环状韧带汇合的部分紧张度无明显变化,在肘关节屈曲过程中,桡侧副韧带将桡骨环状韧带牵拉向上向内,使其内外侧均处于紧张状态;正常肘关节、普通型网球肘、难治性网球肘的头颈距离之间无明显差异,无统计学意义(P>0.05)。肱骨小头关节面外缘内移量之间差异,有统计学意义(P<0.05)。正常肘关节与难治性网球肘有显著性差异(P<0.01)。正位X线片中的肱骨角、尺骨角、颈干角之间差异无统计学意义(P>0.05)。外侧开口角之间差异,有统计学意义(P<0.05)。
结论通过对肱桡关节的解剖结构的观察,为诱发难治性网球肘的可能提供思路及实验依据;肱骨小头关节面外缘内移量BD越长,肱桡关节外侧开口角越大,滑膜嵌顿的机率越大
Objective At present, not yet the main pathological changes of refractory tennis elbow is the brachial and radial synovial incarceration of refractory tennis elbow X-ray signs of in-depth research reports. In order to verify the accuracy and scientific point of view, the correct clinical treatment of refractory tennis elbow provide a theoretical basis, design the project, on the anatomy of the brachial and radial joints brachioradialis joint angles of each bone X-ray observation, Measurement and Analysis
Methods By selecting formalin solution after soaking 20 adult cadaveric elbow specimens;
1.Observe the capitellum and radial head bone sex.
2.Observe the morphology of the elbow joint collateral ligament elbow characteristics and general observation different flexion angles, joint ligament length changes.
3.Observe the elbow joint capsule and the radial collateral ligament of the morphology and the relationship with the synovium.
Select the normal joint X ray pictures brachioradialis 30; common type of tennis elbow X ray image 30; refractory tennis elbow X ray image 30;
1. Do the radial small head inside and outside attachment point P and humerus small head most lateral point A, the line AB and radial small head inside and outside the Angle of attachment that BC to alpha. Also known as radial joint lateral humeral open bickering.
2. Humerus backbone axis HJ by pulley and small head with distal led all line between the horn of delivered by the EF gamma called humerus horns
3. Feet by pulley GO and backbone axis and small head distal led all line between the horn of delivered by the EF the two horns. The beta called
4. With radial neck axis that the horn of radial axis Angle∠Q called neck dry Angle
5. Take the lateral humeral small head, perpendicular to point A radial small head inside and outside attachment for BC, measuring lines point D coque; Also called humerus small head articular surface move quantity in outer.
6. The radial neck extension longitudinal axis from the vertical distance humerus small head low head a neck, called MN
Results The radial collateral ligament and annular ligament in the only point on the ulna,there are two types:the first part of the radial collateral ligament annular ligament fibers to import the ulnar radial point, part of the fiber a little far beyond the ulna alone on; second radial collateral ligament and annular ligament of radius of fiber ends to form a broad ulna. More than 90°elbow flexion, the radialcollateral ligament tension was increased, but the annular ligament and radial convergence of some tension did not change significantly during flexion in the elbow, radial collateral ligament annular ligament of the radial traction up inward, both inside and outside their state of tension; Normal elbows, and regular tennis elbow, difficultly tennis elbow between the head and neck distance, no obvious difference was not statistically significant (P> 0.05). Humerus small head articular surface move quantity in outer are statistically significant differences, between (P< 0.05). Normal elbow and intractable tennis elbow was significant difference (P< 0.01). Is a X-ray of humerus Angle, the two horns, neck dry Angle not statistically significant differences between (P>0.05). The lateral open quarrel, a statistically significant difference between the (P<0.05).
Conclusion the anatomy of the brachial radial structure of the joint observation of the induced refractory tennis elbow may provide ideas and experimental basis; humeral head articular surface of the outer edge of the BD shift more the longer the lateral joint opening angle brachioradialis The larger the greater the probability of incarceration synovial
引文
1.Nirschl RP,Pellrone FA.Medical tennis elbow.Ortho Trans,1980,(3):298.
2. ProtZman RR. Dislocation of the eblow joint. JBoneJointSurgAm,1978, (69):539-541
3. Mehihoff TL, Noble PC, BennettJB, et. simple dislocation of the elbow in the adult. result after closed treatment Bone Joint SurgAln,1988, (70):244-249
4. RingD,JuPiter, JBSandersRW. transolecranon fracture Dislocation of the elbow. Jorthop Traurna,1997, (11):545-550
5. Morrey, BF, AnKN. Functional anatomy of ligament the elbow. Clin orthop, 1985, (201):84-90
6. Fuss, FK. the ulnar collateral ligament of the human eblow joint Anatomay function JAnat,1991, (175):203-221
7. Cohen, MS, Hastingrotatory. insistability of the elbow Theanatomy and role of the latera lstabilizers JBoneJointStlrgAm,1997, (79):225-233
8.Morry BF, TanakaS, AnKN. ValguSstability of the elbow:A definition Of Primary and secondary constraints. ClinonhoP,1991,265-187
9. Morrey, BP, An KN. Function alanat of the ligament soft the Elbow ClinorthoP,1985,201:84-90
10.Cohen, MS, HastingsHH. Rotatoryin stability of the elbow. The anatomy and role of the lateral stabilizers. JBone Joint Surg,1997,79(A):225-233
11.Olsen BS,SojbjergJO, DalstraMetal. Kinematie soft the Lateral ligament constraint of the elbow joint. JShoulder Elbo Surg,1996, (5):333-341
12.OlsenBS, Vaesel, SojbjergJo, etal. Lateral collateral Ligament of the elbow.joint. Anatomy and kinematies JShoulder Elbow Surg,1996, (5):103-112
13.Tyrdal, OLsen BS.Herex tension of the elbow joint. Patho anatomy and kinematies of ligament in juries.JShoulder ElbowSurg,1998, (7):272-283
14.Hotehkiss RN. diaplace fractures of the redialhead internal Fixation J Am AeadorthoPSurgoens,1997, (5):1-10
15.王亦地,孟继愚,郭子恒,等.骨与关节损伤,北京:人民卫生出版社, 1990.414-418
16.吉士俊,潘少川,王继孟,等.小儿骨科学.山东:山东科学技术出版社,2000.535
17.柳用墨等.译.骨骺损伤.北京:人民卫生出版社,1987.231
18. Gillingham BL, VightJG. Convergent dislocation of the elbow. Clin OrthoP,1997, (340):198-201
19.北京医学院附属人民医院编,骨科临床及X线检查的基本知识和方法.北京:人民卫生出版社,1976.183
20.毛宾尧.肘关节外科学,上海:上海科技出版社,2002.323
21.贾连顺,徐印坎,张文明,等.儿童肘部损伤1786例临床分析.中华小儿外科杂志,1985,6(8):163-165
22.徐晓峰,沈铁城,刘锦波,等.成人创伤性孤立性桡骨头脱位.中华骨科杂志,2002,(20):85-87
23.郭世级.临床骨科解剖学.天津:天津科学技术出版社,1988.458
24.薛杭兴.70例正常肘关节的X线测量.医学资料汇编,1979,(3):30-35.
25.蒲文生.肘关节损伤的X线诊断分析.中外医用放射技术,1997,(3):53-54
26.李晓峰,薛清.外伤致儿童肘关节肱骨小头骨骺分离骨折的X线诊断.齐齐哈尔医学院学报,1997,(18):276
27.许开喜.肘关节创伤的X线诊断.中外医用放射技术,1998,(1):38-39
28.方锦山.肘关节损伤X线漏误诊的回顾性分析.中外医用放射技术,1998,(3):90-91.
29.徐浩然.儿童肱骨下端骨骺分离9例误诊原因分析.南通医学院,1998,(3):183-396.
30.李景学,孙鼎.元骨关节X线诊断学.北京:人民卫生出版社,1997,76
31.Nikitiuk IE, ovsiankin NA. HeterotoPic ossifieation as a compliation of Facture-disloeations of the forearm in children. Vesin Khir Imll Gek,1996,155(5):62-65
32.邹仲.X线检查技术学.上海:上海科技出版社,1983.57-58
33. Sharat P, Maffulli N. Tennis elbow. Sports Exercise Injury,1997,3 (2) 102-107.
34.乔若愚.肱骨外上髁骨炎的病因及治疗,中华外科杂志,1965,(13):1997
35.乔若愚,舒敬桑.再论网球肘的病因,第一届全国骨科学术会议论文摘要,1980,(3):128
36.杜心如.伸肌总腱起始部及微血管神经束切除治疗肱骨外上髁炎20例报告,骨与关节损伤杂志,1994,(4):238-239
37.杨正荣.网球肘病因探讨,人民军医,1987,(5):46
38.杜心如,徐恩多,舒强,等.伸肌总腱起始部形态及其临床意义,中国临床解剖学杂志,1993,(11):102
39.杜心如,韩子玉,徐恩多,等.肱骨外上髁炎病因的解剖学研究,中国临床解剖学杂志,1992,(10):6
40. MillerTT. imaging of elbow disorder. orthop Clin North Am,1999, (30):21-36
41.刘振光,吴林兰,李勇光,等.小切口手术治疗顽固性网球肘22例临床疗效观察.中国中医骨伤科杂志,2007,(11):22
42.万全庆.针刀治疗顽固性网球肘45例.浙江中医药大学学报,2006,(4):3
43. Nirschl RP, Pettrone FA. Tennis elbow. the surgical treatment of lateral ep icondilytis. J Bone Joint Surg Am,1979, (5):832-839.
44.王亦地,孟继愚,郭子恒,等.骨与关节损伤.第1版北京人民卫生出版社,1990,(6)414-418
45. FeitzRC, Steinbaeh LS, Tirman, etal. MR imaging of the elbow. Radiol Clin North Am,1997, (35):117-125
1.Nirschl RP,Pellrone FA.Medical tennis elbow.Ortho Trans,1980,(3):298.
2.朱盛修.现代骨科手术学.北京:北京科学技术出版社,1997.1493-1495
3.李良华,李廷泰,卢心宇.神经血管束切除治疗顽固性网球肘.中国骨与关节损伤杂志,1996,11(6):373-375
4.殳跃飞,雷云龙.小针刀治疗顽固性肱骨外上髁炎90例小结.中医正骨,1999,11(2):20~22
5.杜心如.伸肌总腱起始部及微血管神经束切除治疗肱骨外上髁炎20例报告.骨与关节损伤杂志,1994,(4):238-239
6.卢美源,张明.顽固性网球肘的手术治疗.山东医药,1994,(6):23-24
7.陈香仙,何章明.颈源性网球肘推拿与康复训练研究.安徽师范大学学报,2010,(04):393-395
8.贾连顺,李家顺.颈椎外科学.上海:远东出版社,2001,84
9.梁建新,赵尔弘.顽固性网球肘从颈论治及临床分析.中国中医骨伤科杂志,2004,(02):24-26
10.贾松.肱骨外上髁炎合并C5,6神经根卡压综合征的治疗.中国骨伤,2004,17(12):758-759
11.Nirschl RP.Mesenchymal syndrome.VA MED Monthly,1996, (96):659
12..朱盛修.周围神经显微修复学.北京:科学出版社,1991,245-254
13.周游.相关周围神经通道的潜在性病因与肱骨外上髁炎的发病和防治.中国中医骨伤科杂志,1996,(04):30-32
14.陈刚,江华,林子豪,刘安堂,李文鹏,张盈帆,党瑞山,沈辉.尺侧腕伸肌内神经血管分布的应用解剖.中华显微外科杂志,2006,(04):271-273
15.郭照德,韩光宇,王志勇.网球肘的成因及其与解剖结构的关系.新乡医学院学报,2007,(03):254-257
16.黄祁平,肖建忠,蒋桂风.基于网球训练中肘部韧带损伤机制的运动解剖学研究.天津体育学院学报,2006,21(3):2112-2113.
17.范炳华,谢远军,叶金波.桡尺近侧关节损伤与网球肘的鉴别及手法治疗.中国骨伤,2007,(06)21-22
18.张育,袁宪海,刘爱真.肱骨外上髁炎的治疗进展.中医正骨,1998,(01):50-51
19.邵宣,许竟斌,史可任,等.实用颈腰背痛学.北京:人民军医出版社,1992,98~111
20.张善东,梁建新,赵尔弘,等.顽固性网球肘从颈论治及临床分析.中国骨伤,2004,12(2):24