Owens B D, Murphy K P, Kuklo T R
Orthopaedic Surgery Service, Walter Reed Army Medical Center, Washington, D.C. 20307, U.S.A.
Arthroscopy. 2001 Jul;17(6):582-7. doi: 10.1053/jars.2001.20098.
This study was performed to review the results of our early experience with recalcitrant lateral epicondylitis treated arthroscopically.
This study is a case series consisting of consecutive patients with lateral epicondylitis treated arthroscopically by 1 surgeon.
Patients failing a minimum of 6 months of conservative treatment underwent arthroscopic release of the extensor carpi radialis brevis (ECRB) origin using the proximal medial and proximal lateral portals. Associated intra-articular pathology was noted and addressed. The ECRB lesions were classified according to their gross morphology and resected with a shaver. The lateral epicondyle was then decorticated with a burr.
Sixteen patients with recalcitrant lateral epicondylitis were treated with arthroscopic release of the ECRB origin on the lateral epicondyle. Of the 16 elbows undergoing surgery, 5 (31.3%) were noted to have a type I lesion, characterized as fraying of the undersurface of the ECRB. Five (31.3%) had a type II lesion noted by linear tears within the ECRB, and 6 (37.5%) had a type III lesion, consisting of a partial or complete avulsion of the ECRB origin. Concurrent intra-articular pathology (synovitis, osteophytes) was noted in 3 of 16 elbows (18.8%) and was addressed arthroscopically. All patients were followed-up for a minimum of 1 year; however, 4 patients were lost to follow-up for this retrospective review due to military reassignment. Follow-up was obtained on 12 of 16 (75%) of patients at an average length of 24.1 months (range, 15 to 33 months). All patients reported improvement with the procedure. The average return to unrestricted work was 6.0 days (range, 0 to 28 days).
Arthroscopic release effectively treats lateral epicondylitis while also affording visualization of the joint space to address associated intra-articular pathology. Additionally, arthroscopic release is minimally invasive and allows early rehabilitation and return to normal activities.
本研究旨在回顾我们早期对顽固性外侧上髁炎进行关节镜治疗的结果。
本研究是一个病例系列，由一名外科医生对连续的外侧上髁炎患者进行关节镜治疗组成。
至少经过6个月保守治疗失败的患者，通过近端内侧和近端外侧入路进行关节镜下桡侧腕短伸肌（ECRB）起点松解。记录并处理相关的关节内病变。根据ECRB病变的大体形态进行分类，并用刨削器切除。然后用磨钻对外侧上髁进行去皮质处理。
16例顽固性外侧上髁炎患者接受了关节镜下外侧上髁ECRB起点松解术。在接受手术的16个肘部中，5个（31.3%）被发现有I型病变，其特征为ECRB下表面磨损。5个（31.3%）有II型病变，表现为ECRB内的线性撕裂，6个（37.5%）有III型病变，包括ECRB起点的部分或完全撕脱。16个肘部中有3个（18.8%）同时存在关节内病变（滑膜炎、骨赘），并通过关节镜进行了处理。所有患者至少随访1年；然而，由于军事调动，4例患者在本次回顾性研究中失访。16例患者中有12例（75%）获得随访，平均随访时间为24.1个月（范围15至33个月）。所有患者均报告手术效果良好。恢复无限制工作的平均时间为6.0天（范围0至28天）。
关节镜下松解术能有效治疗外侧上髁炎，同时还能观察关节间隙以处理相关的关节内病变。此外，关节镜下松解术微创，能使患者早期康复并恢复正常活动。
