【作者】 朱胤晟；

【导师】 杨米雄；

【作者基本信息】 浙江中医药大学 ， 中医骨伤科学， 2011， 硕士

【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∠Q5.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更多还原

【Abstract】 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 AnalysisMethods 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 horns3. 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 called4. With radial neck axis that the horn of radial axis Angle∠Q called neck dry Angle5. 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 MNResults 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更多还原