摘要目的 分析Coonrad-Morrey假体全肘关节置换术后的肘关节力线,建立健康成人正常肘关节与假体设计相关的解剖参数,探讨Coonrad-Morrey假体与中国成人肘关节解剖形态的匹配性.方法 招募健康成人志愿者42名摄双侧肘关节正位X线片84张;通过图像存档系统收集正常肘关节正位X线片99张;采用Coonrad-Morrey假体行全肘关节置换术后肘关节正位X线片54张.于X线片上测量:肱骨-肘-腕(humerus-elbow-wrist,HEW)角、肱骨干髓腔长轴与肘关节屈戌轴的桡侧夹角(肱轴角)、尺骨干中段髓腔长轴与肘关节屈戌轴的桡侧夹角(尺中轴角)、尺骨干近端髓腔长轴与肘关节屈戌轴的桡侧夹角(尺近轴角)、肱骨和尺骨近端髓腔长轴的水平距离(髓腔偏移度).分析正常肘关节和全肘关节置换术后肘关节形态学指标的差异,正常肘关节的形态学指标是否存在性别、侧别差异及与身高的相关性.结果 全肘关节置换术后HEW角(2.71°±8.08°)及髓腔偏移度[(1.79±3.49) mm]小于正常肘关节[分别为11.30°±7.21°、(5.25±2.55) mm],差异有统计学意义;肱轴角(89.92°±3.64°)、尺中轴角(93.34°±6.30°)、尺近轴角(78.87°±4.79°)大于正常肘关节(分别为87.59°±5.62°、89.23°±5.66°、76.22°±4.69°),差异有统计学意义.右肘关节,女性肱轴角大于男性.其余各指标的性别、侧别差异无统计学意义.各指标与身高的相关性均无统计学意义.结论 国人Coonrad-Morrey假体全肘关节置换术后肘关节较正常肘关节外翻减小且前臂向外侧平移,Coonrad-Morrey假体存在使国人全肘关节置换术后前臂向外侧平移且肘关节外翻减小的设计因素.

abstractsObjective To investigate the alignment of the elbow after Coonrad-Morrey (CM) total elbow arthroplasty (TEA),and to establish normal radiographic parameters correlated with prosthesis design in Chinese adults,as well as to detect whether CM prosthesis fits for Chinese.Methods Forty-two healthy volunteers were recruited and underwent radiographs of bilateral elbows in a standardized anterior-posterior (AP) fashion.Furthermore,99 AP radiographs of normal elbows and 54 AP radiographs of elbows after CM TEA were both collected from Picture Archiving and Communication System.The following radiographic parameters were measured:humerus-elbow-wrist (HEW) angle,the angle between the axis of humerus medullary cavity and the hinge axis of elbow (H-H angle),the angle between the axis of middle ulna medullary cavity and the hinge axis of elbow (MU-H angle),the angle between the axis of proximal ulna medullary cavity and the hinge axis of elbow (PU-H angle),the horizontal distance between the axis of humerus medullary cavity and the axis of proximal ulna medullary cavity (medullary translation).The differences in above parameters between normal elbows and elbows after CM TEA were compared.For normal elbows,the radiographic differences between male and female and that between right and left were analyzed,as well as the correlation with height.Results HEW angle (2.71°±8.08°) and medullary translation (1.79±3.49 mm) in patients after CM TEA were significantly less than that in normal (11.30°±7.21°,5.25±2.55 mm respectively),while H-H angle (89.92°±3.64°),MU-H angle (93.34°±6.30°) and PU-H angle (78.87°±4.79°) were significantly larger than that in normal (87.59°±5.62°,89.23°±5.66°,76.22°±4.69° respectively).The right HH angle of female was significantly larger than that in male.There were no significant difference in other parameters between male and female,and between right and left.All of the correlations between these parameters and height were not significant.Conclusion Elbow valgus decreases and forearm translates laterally after CM TEA in Chinese patients.Currently,the CM prosthesis can theoretically cause decreasing elbow valgns and lateral translation of forearm.