Department of Orthopedic Surgery, WellStar Atlanta Medical Center.
Department of Orthopedic Surgery, WellStar Atlanta Medical Center, The Hand and Upper Extremity Center of Georgia, Atlanta, GA.
Tech Hand Up Extrem Surg. 2022 Dec 1;26(4):271-275. doi: 10.1097/BTH.0000000000000398.
Lateral epicondylitis afflicts a large percentage of the population with most recovering through conservative treatment. The 5% to 10% of patients who undergo operative intervention are met with mixed results. Those that fail to improve often demonstrate a complex presentation of inadequate debridement of the "angiofibroblastic tissue," missed concomitant radial tunnel syndrome, and iatrogenic residual devascularized tissue resulting from the index procedure. To address all 3 of these causes of failure, the authors have developed a revision procedure that includes repeat debridement of residual tendinosis, decompression of the posterior interosseous nerve, and a vascularized anconeus muscle flap to help cushion soft tissue defects and promote a healthier environment for healing. Performed initially in part in 20 patients, this combined procedure has developed into our recommended treatment for these challenging patients.
外侧上髁炎影响了很大一部分人群，大多数患者通过保守治疗即可康复。5%至 10%接受手术干预的患者则会得到混合结果。那些没有改善的患者通常表现为“血管纤维组织”清理不充分、同时存在桡神经管综合征漏诊、以及指数手术导致的医源性残余去血管化组织等复杂表现。为了解决所有这 3 种失败原因，作者开发了一种修正手术，包括对残余肌腱病进行重复清理、骨间后神经减压，以及使用血运丰富的肘肌瓣来帮助缓冲软组织缺损并为愈合创造更健康的环境。该联合手术最初在 20 名患者中部分进行，现已发展成为我们对这些具有挑战性的患者的推荐治疗方法。
