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[慢性外侧上髁炎中伸肌总腱的经骨固定术:伴或不伴外侧尺侧副韧带额外重建——101例患者的回顾性评估]

[Transosseous refixation of the common extensor muscle tendons in chronic lateral epicondylitis with and without additional reconstruction of the LUCL--a retrospective evaluation of 101 patients].

作者信息

Ries C, Franke S, Dietrich F, Jakubowitz E, Dehlinger F, Hollinger B

机构信息

Klinik für Orthopädie und Unfallchirurgie, ARCUS Kliniken Pforzheim, Rastatter Strasse 17, Pforzheim.

出版信息

Z Orthop Unfall. 2013 Jun;151(3):296-301. doi: 10.1055/s-0032-1328578. Epub 2013 May 21.

Abstract

INTRODUCTION

The chronic lateral epicondylitis (EHR) as a common pathology of the elbow is often associated with posterolateral rotatory instability of the elbow (PLRI). After evaluation of intra-articular pathology by prior diagnostic arthroscopy, we aimed to build patient groups regarding the stability of the elbow joint. In patients with a stable elbow joint, open surgery with a debridement to the origin of the common extensor tendon and transosseous refixation was performed. Patients with relevant posterolateral rotatory instability, however, underwent an additional LUCL complex stabilisation using triceps tendon graft besides debridement as mentioned above. The purpose of this study was to evaluate and compare the clinical functional outcome between these groups.

MATERIAL AND METHODS

101 patients were included in our study. Arthroscopies were first performed on all patients to identify intra-articular pathological changes. In 26 patients with stable elbows, open surgery with debridement to the origin of the common extensor tendon and transosseous refixation was performed. For the other 75 patients who were found presenting a relevant posterolateral rotatory instability, a stabilisation of the LUCL in addition to the open procedure mentioned above was performed. Examinations and questionnaires were used for retrospective evaluation at follow-up.

RESULTS

Both groups of patients revealed significant improvement in pain relief and elbow function. We observed no significant difference between the two methods concerning clinical and functional outcome.

CONCLUSION

We recommend diagnostic arthroscopy with assessment of stability prior to the open performance to offer a more reliable evidence for surgical technique selection and therefore to achieve a better clinical outcome.

摘要

引言

慢性外侧上髁炎(EHR)作为肘部常见的病理状况,常与肘部后外侧旋转不稳定(PLRI)相关。在通过先前的诊断性关节镜检查评估关节内病理状况后,我们旨在根据肘关节的稳定性建立患者分组。对于肘关节稳定的患者,进行开放性手术,清理伸肌总腱起点并进行经骨重新固定。然而,对于存在相关后外侧旋转不稳定的患者,除上述清理外,还使用肱三头肌腱移植物进行外侧副韧带复合体的额外稳定术。本研究的目的是评估和比较这些组之间的临床功能结果。

材料与方法

101例患者纳入我们的研究。首先对所有患者进行关节镜检查以确定关节内的病理变化。对于26例肘关节稳定的患者,进行开放性手术,清理伸肌总腱起点并进行经骨重新固定。对于另外75例发现存在相关后外侧旋转不稳定的患者,除上述开放性手术外,还进行了外侧副韧带的稳定术。在随访时使用检查和问卷进行回顾性评估。

结果

两组患者在疼痛缓解和肘关节功能方面均有显著改善。我们观察到两种方法在临床和功能结果方面无显著差异。

结论

我们建议在进行开放性手术前进行诊断性关节镜检查并评估稳定性,以便为手术技术选择提供更可靠的依据,从而获得更好地临床结果。

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