Applied Anatomy And Clinical Significance Of The Elbow

Objective: Through the autopsy laboratory observation and recording of relevant data of the anatomical and mobile characteristics of medial and radial collateral ligament of the elbow and anatomical relation of radial head and neck structure and post-rotation musle and radial nerve.To evalvate the role medial and radial collateral ligament and radial in maintioning stability of elbow joint,providing theoretical foundation support for clinnical operation.Methods There were 20cases(40 sides)embaded adult cadaveric elbows to dissect and test in this study.removing the elbow distal and nearly 20 cm range most of the soft tissue,to keep the lateral and collateral ligament tissue.radial nerve and supinator musle.To observe the morphology of the medial and lateral collateral ligaments and anular ligaments.gross measuring the length of the ligaments at 0°、30°、60°、90°、120°angle of the elbow flexion with a vernier caliper(accutate to 0.01mm)and observing the tensen of ligaments.Selecting 20 sides of the speciments to observe the anatomic relationship between the head and neck of radius and supinator muscle and deep branch of radial nerve.The following measurements were performed separately at the extreme pronation of the forearm:vertical distances between the exit and enter point of deep branch of radial nerve from the supinator tunel and radial head piane and the epicondylar of the humerus.And then all the data were analyzed staistically.Result: 1.Ulnar collateral ligament of the elbow which fiber rear fan distribution in the sagittal plane downward foot up to the epicondyle of the humerus,stop at ulna coronoid process medial tubercle and the inside of the half moon cut mark of ulna olecranon,which can be divided into anterior and posterior bundles according to the distribution of fibers.The direction of the anterior fiber is consistent with the longitudinal direction of the ulna,and the direction of the posterior fiber is perpendicular to the verical axis of the ulna.According to the shape and distribution of the collateral ligament in the elbow joint,the specimens were divided into three types.The average length of the anterior fasiculus anterior and posterior fascicle of the ulnar collateral ligament at elbow flexion0°、30°、60°、90°、120°:anterior fiber of anterior bundles(21.6±0.81)mm 、(22.1±0.62)mm 、(22.2±0.83)mm 、(21.9±0.84)mm 、(20.7±0.75)mm.posterior of anterior bundles(17.8±1.51)mm 、(18.0±1.12)mm、(17.9±0.70)mm、(21.3±1.64)mm、(22.3±1.8)mm.posterior bundles(15.0±2.36)mm、(15.0±2.24)mm、(16.1±1.67)mm、(18.4±1.65)mm、(20.6±2.34)mm.2.The radial collatereral ligament complex is composed of the radial collateral ligament and the circular ligament.The radial collateral ligament begin from the lower part of the epicondyle of the humerus,and the fibers in the front end in the circular ligaments,and the posterior fibers end in the lower part of the ulnar coronoid process.According to the shape and distribution of the radial collateral ligament in the elbow joint,the specimens were divided into three types,The average length of the anterior bundles、anterior part and posterior part of the radial collateral ligament at elbow flexion0°、30°、60°、90°、120°:anterior bundles(19.09±2.67)mm、(20.34±2.88)mm、(21.66±2.76)mm、(22.77±3.08)mm、(23.82±3.13)mm,posterior part(13.55±0.45)mm、(14.23±0.56)mm、(15.24±0.88)mm、(15.11±0.64)mm、(14.61±0.67)mm,anterior part(32.61±3.30)mm、(33.72±3.20)mm、(35.07±3.63)mm、(36.05±3.54)mm、(37.03±3.65)mm.3.The average distances between the initial point of deep branch of radial nerve and the epicondylar of humerus were(38.65±2.05)mm.The average distances between the entry point of deep branch of radial nerve from the supinator tunnel and the epicondylar of humerus were(73.26±78)mm.The average distances between the exit point of deep branch of radial nerve from the supinator tunnel and the epicondylar of humerus were(73.26±78)mm.The average lengthes of deep branch of radial nerve in the supinator tunnel were(40.42±8.52)mm.The average distances from the intersection point between nerve and outboard radius neck center line to radius head were(43.13±2.2)mm.The average angle between line of the supinator entery and exit piont and line connecting lateral condyle of humerus and radial nerve were(31.5°±1.6°).The average distances between the initial point of deep branch of radial nerve and radius head were(11.16±3.5)mm.The average distances between the entry point of deep branch of radial nerve from the supinator tunnel and radius head were(13.82±4.1)mm.The average distances between the exit point of deep branch of radial nerve from the supinator tunnel and radius head were(64.52±2.7)mm.4.Treated 6 cases of the terrible triad of elbow by internal and lateral combined approach surgical method.According to Mayo elbow score criteria: excellent in 3cases,good in 2 cases,fair in 1 case.Conclusion:1.The lateral collateral ligament and the ulnar collateral ligament of the elbow were important structures to maintain the stablity of the elbow joint.The different components of the accessory ligament in the elbow joint play a different role in stabilizing the joint.2.The lateral ulnar collateral ligament and the anterior bundle of the ulnar collateral ligament of the elbow play an important part in the stable.Its repair and reconstruction is the key of the surgical operation in treating elbow injury.3.There is an operation safe area on the outside of the elbow joint,and the operation of radial head surgery in this area can minimize the occurrence of postoperative complications.4.Internal and lateral combined approach operation is an effective way to treat Terrible triad of the elbow.