Arrigoni P, Zottarelli L, Spennacchio P, Denti M, Cabitza P, Randelli P
Dipartimento di Scienze Medico-Chirurgiche, IRCCS Policlinico San Donato, Università degli Studi di Milano, Piazza Edmondo Malan 2, 20097 San Donato Milanese, Milan, Italy.
Musculoskelet Surg. 2011 Jul;95 Suppl 1:S7-11. doi: 10.1007/s12306-011-0118-7.
Lateral epicondylitis requires a challenging therapeutic management even for expert surgeons. With the failure of conservative treatment, the physician should consider a surgical choice. The purpose of the surgical procedure is to excise the degenerated tissue of extensor carpi radialis brevis tendon. This article describes the arthroscopic release, performed under direct visualization with a 70° scope; the aim is to encourage the use of this type of lens, versus the traditional 30° one. The patient is positioned in a modified lateral decubitus. After joint distension, a diagnostic arthroscopy of the posterior compartment is performed as first step. Then, an anterior compartment arthroscopic evaluation, a subsequent antero-lateral capsulectomy, and extensor carpi radialis brevis tendon exposition are performed with a 30° view. At this point, the 70° lens is switched and the tendon release is performed under direct control. The 70° lens allows a safer procedure, but requires a dedicated learning curve.
即使对于专业外科医生而言，外侧上髁炎的治疗管理也颇具挑战性。保守治疗失败后，医生应考虑手术治疗。手术的目的是切除桡侧腕短伸肌腱的退变组织。本文描述了在70°关节镜直视下进行的关节镜松解术；目的是鼓励使用这种类型的镜头，而非传统的30°镜头。患者取改良侧卧位。关节扩张后，第一步先对后关节腔进行诊断性关节镜检查。然后，通过30°视角进行前关节腔关节镜评估、随后的前外侧关节囊切除术以及桡侧腕短伸肌腱暴露。此时，更换70°镜头并在直接控制下进行肌腱松解。70°镜头使手术更安全，但需要专门的学习曲线。
