Kuklo T R, Taylor K F, Murphy K P, Islinger R B, Heekin R D, Baker C L
Orthopaedic Surgery Service, Walter Reed Army Medical Center, Washington, DC 20307, USA.
Arthroscopy. 1999 Apr;15(3):259-64. doi: 10.1016/s0749-8063(99)70031-9.
At least 10 different surgical approaches to refractory lateral epicondylitis have been described, including an arthroscopic release of the extensor carpi radialis brevis tendon. The advantages of an arthroscopic approach include an opportunity to examine the joint for associated pathology, no disruption of the extensor mechanism, and a rapid return to premorbid activities with possibly fewer complications. A cadaveric study was performed to determine the safety of this procedure. Ten fresh-frozen cadaveric upper extremities underwent arthroscopic visualization of the extensor tendon and release of the extensor carpi radialis brevis tendon. The specimens were randomized with regard to the use of either a 2.7-mm or a 4.0-mm 30 degree arthroscope through modified medial and lateral portals. Following this, the arthroscope remained in the joint, and the portal, cannula track, and surgical release site were dissected to determine the distance between the cannula and the radial, median, ulnar, lateral antebrachial, and posterior antebrachial nerves, and the brachial artery and the ulnar collateral ligament. No direct lacerations of neurovascular structures were identified; however, the varying course of the lateral and posterior antebrachial nerves place these superficial sensory nerves at risk during portal placement. As in previous reports, the radial nerve was consistently in close proximity to the proximal lateral portal (3 to 10 mm: mean, 5.4 mm). The ulnar collateral ligament was not destabilized. Arthroscopic release of the extensor carpi radialis brevis tendon appears to be a safe, reliable, and reproducible procedure for refractory lateral epicondylitis. Cadaveric dissection confirms these findings.
针对难治性外侧上髁炎，已描述了至少10种不同的手术入路，包括关节镜下桡侧腕短伸肌腱松解术。关节镜入路的优点包括有机会检查关节是否存在相关病变、不破坏伸肌机制，以及能快速恢复到病前活动状态且并发症可能更少。进行了一项尸体研究以确定该手术的安全性。对10个新鲜冷冻的尸体上肢进行了关节镜下伸肌腱可视化及桡侧腕短伸肌腱松解术。通过改良的内侧和外侧入路，随机使用2.7毫米或4.0毫米30度关节镜对标本进行操作。此后，关节镜留在关节内，解剖入路、套管通道和手术松解部位，以确定套管与桡神经、正中神经、尺神经、前臂外侧皮神经、前臂后皮神经、肱动脉和尺侧副韧带之间的距离。未发现神经血管结构有直接损伤；然而，前臂外侧和后皮神经走行各异，在放置入路时这些浅表感觉神经有受损风险。与之前的报告一样，桡神经始终紧邻近端外侧入路（3至10毫米：平均5.4毫米）。尺侧副韧带未出现不稳定。关节镜下桡侧腕短伸肌腱松解术对于难治性外侧上髁炎似乎是一种安全、可靠且可重复的手术。尸体解剖证实了这些发现。
