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[慢性外侧上髁炎:尼氏手术]

[Chronic lateral epicondylitis : The Nirschl procedure].

作者信息

Müller A, Spies C K, Unglaub F, Bruckner T, Pötzl W

机构信息

Abteilung für Schulter- und Ellenbogenchirurgie, Vulpius Klinik, Vulpiusstr. 29, 74906, Bad Rappenau, Deutschland.

Abteilung für Handchirurgie, Vulpius Klinik, Vulpiusstraße 29, 74906, Bad Rappenau, Deutschland.

出版信息

Oper Orthop Traumatol. 2015 Dec;27(6):525-35. doi: 10.1007/s00064-015-0426-4. Epub 2015 Oct 29.

DOI:10.1007/s00064-015-0426-4
PMID:26514958
Abstract

PURPOSE

Reduction of burden insufficiency.

INDICATION

Chronic lateral epicondylitis.

CONTRAINDICATIONS

Acute infection in the surgical area. C6/7 nerve root and plexus irritation. Frohse Arcade syndrome. Posterolateral rotatory instability.

SURGICAL TECHNIQUE

Incision slightly cranial to the radial epicondyle. Identification of the extensor carpi radial brevis tendon (ERCB) and longus (ECRL). Mobilisation of the ECRL tendon, identification of degenerative tendons of the ECRB. Excision of degenerative tissue. Drill holes in the area of the smoothed radial epicondyle, thermal denervation.

POSTOPERATIVE MANAGEMENT

Arm plaster splint for 14 days. Unrestricted activity after 4-6 weeks. Maximum loading after 6 months.

RESULTS

Of the 24 consecutively operated patients, 83.3 % were included. High patient satisfaction. Nirschl tennis and elbow score improved from 35 to 75 points postoperatively. Pain levels decreased from 6.8 to 1.4 points postoperatively.

摘要

目的

减轻负荷不足。

适应症

慢性外侧上髁炎。

禁忌症

手术区域急性感染。C6/7神经根和神经丛刺激。弗罗泽弓综合征。后外侧旋转不稳定。

手术技术

在桡骨外侧髁稍上方做切口。识别桡侧腕短伸肌腱(ERCB)和桡侧腕长伸肌腱(ECRL)。游离ECRL肌腱,识别ERCB的退变肌腱。切除退变组织。在打磨后的桡骨外侧髁区域钻孔,进行热去神经支配。

术后处理

用手臂石膏夹板固定14天。4 - 6周后可进行无限制活动。6个月后可进行最大负荷活动。

结果

在24例连续接受手术的患者中,83.3%纳入研究。患者满意度高。术后Nirschl网球肘评分从35分提高到75分。疼痛程度从术后的6.8分降至1.4分。

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Nirschl surgical technique for concomitant lateral and medial elbow tendinosis: a retrospective review of 53 elbows with a mean follow-up of 11.7 years.Nirschl 外科技术治疗肘内、外侧同时发生的肌腱病:53 例平均随访 11.7 年的回顾性研究。
Am J Sports Med. 2011 May;39(5):972-6. doi: 10.1177/0363546510390452. Epub 2011 Jan 10.
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Arthroscopic debridement of the extensor carpi radialis brevis for recalcitrant lateral epicondylitis.关节镜下桡侧腕短伸肌清创术治疗顽固性外上髁炎。
J Shoulder Elbow Surg. 2010 Jul;19(5):651-6. doi: 10.1016/j.jse.2010.02.008.
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Surgical treatment for lateral epicondylitis: a long-term follow-up of results.
成人外侧肱骨髁炎临床检查的差异,考虑其活动水平:测试可靠性、超声成像准确性以及与能量消耗的关系。
Int J Environ Res Public Health. 2023 Jan 18;20(3):1794. doi: 10.3390/ijerph20031794.
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Validation of a novel magnetic resonance imaging classification and recommended treatment for lateral elbow tendinopathy.新型磁共振成像分类法及外侧肘肌腱病推荐治疗方法的验证。
BMC Musculoskelet Disord. 2022 Aug 22;23(1):803. doi: 10.1186/s12891-022-05758-z.
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Anatomical variability and histological structure of the ulnar nerve in the Guyon's canal.Guyon管内尺神经的解剖变异与组织学结构
Arch Orthop Trauma Surg. 2017 Feb;137(2):277-283. doi: 10.1007/s00402-016-2616-4. Epub 2016 Dec 23.
外侧肱骨上髁炎的手术治疗:结果的长期随访。
J Shoulder Elbow Surg. 2010 Apr;19(3):363-7. doi: 10.1016/j.jse.2009.09.008. Epub 2009 Dec 11.
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Is tendon pathology a continuum? A pathology model to explain the clinical presentation of load-induced tendinopathy.肌腱病变是一个连续的过程吗?一种病理学模型来解释负荷诱导的腱病的临床表现。
Br J Sports Med. 2009 Jun;43(6):409-16. doi: 10.1136/bjsm.2008.051193. Epub 2008 Sep 23.
5
Extra-articular arthroscopic lateral elbow release.关节镜下外侧肘关节关节外松解术
Arthroscopy. 2008 Apr;24(4):483-5. doi: 10.1016/j.arthro.2007.07.015.
6
Ten- to 14-year follow-up of the Nirschl surgical technique for lateral epicondylitis.对Nirschl治疗外侧上髁炎手术技术的10至14年随访。
Am J Sports Med. 2008 Feb;36(2):261-6. doi: 10.1177/0363546507308932. Epub 2007 Nov 30.
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J Shoulder Elbow Surg. 2006 Nov-Dec;15(6):721-7. doi: 10.1016/j.jse.2006.01.017. Epub 2006 Sep 11.
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