Marinello Patrick G, Peers Sebastian, Styron Joseph, Pervaiz Khurram, Evans Peter J
*Department of Orthopedic Surgery, Cleveland Clinic, Cleveland, OH †Orthopaedic Associates of Central Maryland, Centers of Advanced Orthopaedics, Baltimore, MD.
Tech Hand Up Extrem Surg. 2015 Jun;19(2):60-3. doi: 10.1097/BTH.0000000000000079.
During a posterior approach to the elbow, the triceps muscle body and tendon insertion must be addressed during exposure. Several methods exist including performing an olecranon osteotomy. The triceps fascial tongue exposure, originally described by Van Gorder in 1940, provides an excellent view of the joint while causing minimal trauma to the extensor mechanism facilitating tendon healing, and easy intraoperative conversion from fracture fixation to a total elbow arthroplasty if a fracture is not able to be reconstructed. Using a standard posterior approach to the elbow, a triceps tongue is created. A distally based flap of the triceps tendon approximately 10 cm long and 2 to 3 cm wide is created and a remnant of the tendon is kept on all sides to secure a meticulous repair with nonabsorbable figure-of-eight sutures at the conclusion of the case. In our case series, 29 patients underwent 30 total elbow arthroplasties. There were no triceps-related failures. This surgical technique is a useful alternative surgical exposure to the posterior elbow for fractures and arthroplasty.
在肘关节后路手术中，暴露过程中必须处理肱三头肌肌腹和肌腱附着点。有多种方法，包括进行鹰嘴截骨术。1940年由范·戈德首次描述的肱三头肌筋膜舌状暴露法，能提供极佳的关节视野，同时对伸肌机制造成的创伤最小，有利于肌腱愈合，并且如果骨折无法重建，术中可轻松从骨折固定转换为全肘关节置换术。采用标准的肘关节后路手术方法，制作一个肱三头肌舌状瓣。制作一个以远端为基底的肱三头肌腱瓣，长约10厘米，宽2至3厘米，在肌腱四周保留残余部分，以便在手术结束时用不可吸收的8字缝线进行精细修复。在我们的病例系列中，29例患者接受了30次全肘关节置换术。没有与肱三头肌相关的失败病例。这种手术技术是一种用于肘关节后路骨折和置换术的有用的替代手术暴露方法。
