肘关节镜序贯性建立前方三入路技术治疗顽固性网球肘  

Anterior three-portal sequential technique in arthroscopic surgical treatment of recalcitrant tennis elbow

作　　者：杨睿[1] 汤毅勇 侯景义[1] 李卫平[1] 黎清悦 于萌蕾[1] 李方奇 张琮达 Yang Rui;Tang Yiyong;Hou Jingyi;Li Weiping;Li Qingyue;Yu Menglei;Li Fangqi;Zhang Congda(Department of Sports Medicine, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou 510120,China)

机构地区：[1]中山大学孙逸仙纪念医院骨外-运动医学科

出　　处：《中华肩肘外科电子杂志》2019年第2期107-114,共8页Chinese Journal of Shoulder and Elbow(Electronic Edition)

基　　金：国家自然科学基金面上项目(81472102);广州市科技计划项目产学研协同创新重大专项(201704020132)

摘　　要：目的评价关节镜下序贯性建立肘关节前方三入路的方法治疗顽固性网球肘的可行性、安全性和有效性.方法回顾性分析2008年1月至2016年12月中山大学孙逸仙纪念医院收治的28例关节镜治疗顽固性网球肘的病例,均采用序贯性建立肘关节前方三入路的方法,镜下彻底清除桡侧腕短伸肌腱(extensor carpi radialis brevis,ECRB)病变的腱性组织,同时清理ECRB止点处肱骨外上髁.通过对比术前、术后的视觉模拟评分(visual analogue scale,VAS)、肌力评分以及简版上肢功能评估(quick-disabilities of arm,shoulder and hand,Quick-DASH)评分,结合末次随访的满意度,评价临床疗效.结果 28例患者均获得12~38个月的随访,临床结果显示患者VAS(夜间痛及活动痛)、肌力评分、Quick-DASH评分术前与末次随访比较,差异具有统计学意义(P<0.01).结合满意度评分末次随访得分为优的患者18例,得分为良的患者6例,优良率为85.7%.所有患者无肘关节神经损伤等并发症.结论通过序贯性建立肘关节前方三入路的方法,关节镜下可以彻底清除ECRB的病变组织,同时可以清理局部肱骨外上髁,是治疗顽固性网球肘的一种微创、安全、有效可行的方法.Background Tennis elbow which is also known as humeral epicondylitis is named for its concentrated outbreak in grass tennis tournament. In fact, neither of these two naming methods can accurately express the pathophysiological process of the disease. Possible pathological changes include the epicondylitis of humerus, the rupture of joint capsule at the lateral epicondyle of humerus, the compression of lateral synovial fold, extensor tendon disease, cartilage injury of brachioradial joint, nerve compression or a mixture of the above. There is no definitive conclusion in current clinical study. In recent years, research has tended to interpret it as one type of tendinopathies near the insertion of the tendon. As extensor tendon extensor carpi radialis brevis( ECRB) is the most common and major cause of this disease, many clinical treatments are aiming at clearing ECRB and obtain good clinical result.Anatomical study has found that ECRB is close to joint capsule, which opens up the possibility of clearing ECRB under elbow arthroscopy. More and more centers are beginning to use this technique to treat the disease. However, the vascular nerves around elbow joint are rich, and the elbow joint cavity is not large with extrem ely irregular s tructure. Also, the elbow joint is prone to postoperative activity limitation, and the elbow arthroscopy learning curve is long. The reasons above limit the development of elbow arthroscopy technique. How to establish a safe, fast and accurate way is the key. Methods Ⅰ. General information. This study provided a retrospective analysis of 28 cases( 11 males and 17 females) of refractory tennis elbow in our hos pital from J anuary 2008 to December 2016. The age ranged from 35-61 years with an average of 45.6 years. 16 cases had the right elbow affected, and 12 cases had the left elbow affected. There were 6 cases with the history of clear sports injury or heavy weight carrying. The clinical manifestation was the lateral pain of elbow joint. 19 patients had the pain radiated to the mi

关 键 词：关节镜 网球肘 桡侧腕短伸肌腱 

分 类 号：R687.4[医药卫生—骨科学]