伸肌腱止点清理带线锚钉修复治疗顽固性网球肘的近期疗效  

SHORT-TERM EFFECTIVENESS OF SUTURE ANCHOR AFTER DEBRIDEMENT OF EXTENSOR TENDON INSERTION FOR RECALCITRANT LATERAL EPICONDYLITIS

作　　者：邓银栓[1,2] 唐康来[1] 李辉[1] 张吉强[3] 谢美明[1] 曹洪辉[1] 陈艳[1] 陈磊[1] 周兵华[1] 谭晓康[1] 许建中[1] 

机构地区：[1]第三军医大学西南医院骨科全军矫形外科中心,重庆400038 [2]兰州军区兰州总医院骨科全军创伤骨科研究所 [3]第三军医大学基础医学院神经生物学教研室重庆市神经生物学重点实验室

出　　处：《中国修复重建外科杂志》2013年第1期1-6,共6页Chinese Journal of Reparative and Reconstructive Surgery

基　　金：国家自然科学基金面上项目(81071464);重庆市自然科学基金重点项目(CSTC2011BA5010);全军医学科研“十一五”计划面上项目(06MB245)~~

摘　　要：目的探讨伸肌腱止点清理带线锚钉修复桡侧腕短伸肌(extensor carpi radialis brevis,ECRB)、指伸肌(extensor digitorum communis,EDC)治疗顽固性网球肘的近期疗效。方法 2009年3月-2011年5月,采用伸肌腱止点清理带线锚钉修复ECRB及EDC治疗单侧顽固性网球肘患者10例。男6例,女4例;年龄36～57岁,平均45.4岁。优势肘8例,非优势肘2例;重体力劳动者4例,普通工作者6例。病程8～24个月,平均12.3个月。患者均有肱骨外上髁部疼痛,局部肿胀压痛,Mill征(+)。肘关节活动范围:伸直0～30°,平均11.3°;屈曲120～145°,平均132.5°。MRI提示均为肱骨外髁炎。结果术后切口均Ⅰ期愈合,无感染、关节液外漏及肘关节强直等并发症发生。10例均获随访,随访时间4～23个月,平均12个月;其中7例随访12个月及以上者均未复发。重体力劳动者术后(3.75±0.95)个月恢复原工作,与普通工作者(2.91±0.20)个月比较,差异无统计学意义(t=1.715,P=0.180)。术后1、3个月及末次随访时疼痛视觉模拟评分(VAS)均较术前显著下降(P<0.05),Mayo评分均较术前显著提高(P<0.05);优势侧及非优势侧握力均较术前显著提高(P<0.05),末次随访时与非手术侧握力比较差异均无统计学意义(P>0.05)。末次随访时肘关节活动范围:伸直0～—10°,平均—1.5°;屈曲140～160°,平均150.5°。结论伸肌腱止点清理带线锚钉修复ECRB及EDC治疗顽固性网球肘,能有效防止前臂伸肌力量潜在丢失,且创伤小,疼痛缓解显著,握力恢复接近正常,近期疗效较好。Objective To analyze the short-term effectiveness of repairing musculus extensor carpi radialis brevis （ECRB） and extensor digitorum communis （EDC） tendon using suture anchor after debridement of extensor tendon insertion for recalcitrant lateral epicondylitis. Methods Between March 2009 and May 2011, 10 patients （10 elbows） with recalcitrant lateral epicondylitis received repair of the ECRB and EDC tendon to the lateral epicondyle using a single suture anchor after debridement of extensor tendon insertion. There were 6 males and 4 females with an average age of 45.4 years （range, 36-57 years）. The dominant elbow was involved in 8 patients and nondominant elbow in 2 patients; there were 4 manual workers and 6 ordinary workers. The disease duration ranged from 8 to 24 months （mean, 12.3 months）. All patients had epicondylus lateralis humeri pain, local swelling and tenderness, and positive Mill sign. The average elbow range of motion （ROM） was 11.3°（range, 0-30°） in extension and was 132.5°（range, 120-145°） in flexion. Preoperative MRI showed external humeral epicondylitis in all patients. ResultsPrimary wound healing was obtained in all patients without complications of infection, leakage of joint fluid, and stiffness of elbow. Ten patients were followed up 4 to 23 months with an average of 12 months （more than 12 months in 7 cases）. The time to return to work was （3.75 ± 0.95） months for manual workers and was （2.91 ± 0.20） months for ordinary workers, showing no significant difference （t=1.715, P=0.180）. Compared with preoperation, the mean visual analogue scale （VAS） score significantly decreased （P 〈 0.05）, and Mayo score and the grip strength of dominant and nondominant significantly increased （P 〈 0.05）, but no significant difference was found when compared with non-surgical side at last follow-up （P 〉 0.05）. At last follow-up, the average ROM was —1.5° （range, 0-—10°） in extension and was 150.5°（range, 140-160°） in

关 键 词：顽固性网球肘 桡侧腕短伸肌 指伸肌 带线锚钉 修复 

分 类 号：R687.2[医药卫生—骨科学]