Degenerative changes in the elbow joint after radial head excision for fracture: quantitative 3-dimensional analysis of bone density, stress distribution, and bone morphology
Degenerative changes in the elbow joint after radial head excision for fracture: quantitative 3-dimensional analysis of bone density, stress distribution, and bone morphology
复制标题
骨折桡骨头切除后肘关节的退行性变化：骨密度、应力分布和骨形态的定量 3 维分析
DOI：
10.1016/j.jse.2020.09.035
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发表时间：
2021
影响因子：
3
通讯作者：
Chen Neal C.
中科院分区：
文献类型：
--
作者：
Miyamura Satoshi;Lans Jonathan;Murase Tsuyoshi;Oka Kunihiro;Chen Neal C.
假设和背景一些研究人员推测切除可能会导致肘关节炎和相关问题；然而，支持这一理论的证据有限。据推测，桡骨头切除会因应力分布不对称而导致骨密度变化，从而导致骨赘形成。在本研究中，我们试图定量比较接受桡骨头切除术的患者手术肘部和非手术肘部的三维（3D）骨密度和应力分布。此外，我们的目的是使用3D模型量化同一队列中的骨形态变化。方法经过回顾性鉴定，本研究纳入6名因桡骨头骨折接受桡骨头切除术的患者。我们使用从受伤和未受伤的肘部获得的计算机断层扫描数据创建了 3D 骨骼模型。将肱骨和尺骨模型分为解剖区域，并通过其高密度体积百分比（％HDV）评估和描述每个区域的骨密度。我们还构建了有限元模型并测量了每个区域的应力值。此外，我们通过将手术肘部叠加到非手术肘部的镜像上来比较骨形态。结果从桡骨头切除到检查的平均间隔为 8.4 ± 3.3 年。肱骨远端前外侧滑车（77.5% ± 6.5% vs. 64.6% ± 4.0%，P= .028）和后外侧滑车（70.7% ± 7.8% vs. 63.1% ± 3.8%，P= .034）区域手术侧的 %HDV 高于非手术侧。在尺骨近端观察到相反的变化，因为外侧冠突的 %HDV 较高（52.6% ± 9.6% 对比 34.2% ± 6.6%，P= .007）。应力分布与骨密度测量结果平行。与非手术侧相比，手术侧肘部表现出增大的小头和加宽、加深的滑车，并有骨赘形成。讨论和结论在接受桡骨头切除治疗的肘部中，我们发现尺肱关节外侧的骨密度和应力变化不对称，以及整个关节的骨形态变化。这些数据支持这样的理论：从长远来看，桡骨头切除会导致尺骨关节炎。
Hypothesis and backgroundSome investigators speculate that excision may lead to elbow arthritis and associated problems; however, evidence supporting this theory is limited. It is hypothesized that radial head excision causes bone density changes as a result of asymmetrical stress distributions, consequently leading to osteophyte formation. In this study, we sought to quantitatively compare the 3-dimensional (3D) bone density and stress distributions between operative and nonoperative elbows in patients who underwent radial head excision. Furthermore, we aimed to quantify the bone morphologic changes using 3D models in the same cohort.MethodsAfter retrospective identification, this study enrolled 6 patients who had undergone radial head excision for radial head fractures. We created 3D bone models using computed tomography data obtained from the injured and uninjured elbows. Humerus and ulna models were divided into anatomic regions, and the bone density of each region was assessed and described by its percentage of high-density volume (%HDV). We also constructed finite element models and measured the stress values in each region. Furthermore, we compared the bone morphology by superimposing the operative elbow onto the mirror image of the nonoperative elbow.ResultsThe mean interval from radial head excision to examination was 8.4 ± 3.3 years. The %HDV on the operative side was higher than that of the nonoperative side at the anterolateral trochlea (77.5% ± 6.5% vs. 64.6% ± 4.0%,P= .028) and posterolateral trochlea (70.7% ± 7.8% vs. 63.1% ± 3.8%,P= .034) regions of the distal humerus. Reciprocal changes were observed in the proximal ulna, as %HDV was higher in the lateral coronoid (52.6% ± 9.6% vs. 34.2% ± 6.6%,P= .007). The stress distributions paralleled the bone density measurements. The operative elbows demonstrated an enlarged capitellum and a widened and deepened trochlea with osteophyte formation compared with the nonoperative side.Discussion and conclusionIn elbows treated with radial head excision, we identified asymmetrical bone density and stress alterations on the lateral side of the ulnohumeral joint and bone morphologic changes across the joint. These data support the theory that radial head excision contributes to ulnohumeral arthritis over the long term.