[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.
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.
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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