网球肘手术相关治疗与效果评价 .pptxVIP

网球肘手术治疗与效果评价2013级临床5班 弓伊宁2016.11.13什么是网球肘肘关节外侧疼痛最常见病因之一！！！历史发展简介 该病在人群中的发病率大约为1.3%，而且不仅发生于网球运动员，普通人也可以出现网球肘，尤其是那些吸烟、肥胖与从事重体力劳动的人群，网球运动员仅占了10%[5]。但是，有50%的网球运动员会发生肘关节的疼痛，在各种原因中网球肘占75%。 Although most patients respond to non-operative management, surgical treatment is necessary in some cases. The number of patients requiring surgery varies. Boyd and McLeod reported that 4%~11% required operative management; a study by Bowen et al reported that 25% of patients required operative management for disabling refractory symptoms. 对于网球肘，90%的人经保守治疗可好转[6]，包括休息、使用支具、物理治疗、体外冲击波治疗、注射治疗、经皮超声腱切断术、细胞再生治疗等[7]。当保守治疗失败后，应当考虑手术治疗。对于保守治疗的时间，不同的学者说法不一，有的人认为应当经过6~12个月[10]或者至少6个月[8]的保守治疗，有的认为应该至少9个月，尤其是在这期间经过三次以上激素治疗无效的[9]。对伸肌总腱、ERCB、ERCL、EDC等的处理。经典的Nirschl术式对伸肌总腱的处理经典的Nirschl术式A gently curved incision approximately 7.6 centimeterslong is made, extending from 2.5 centimeters proximal to the lateral epicondyle to five centimeters distal to it.The deep fascia, which liesimmediately over the extensor aponeurosis, is incised andgently retracted. The extensor carpi radialis longus formsan interface with and lies directly anterior to the extensor aponeurosis（腱膜）. A hemostat（止血钳） identifies the interface between the extensor longus and the extensor aponeurosis . The arrow identifies the lateral epicondyle . Muscle tissue of the extensor longus is visible anterior to the hemostat.The extensor longus is dissected from the lateral epicondyle to the radial head with a scalpel and scissors. Release and retraction of the extensor carpi radialis longus from the anterior edge of the extensor aponeurosis then reveals the origin of the extensor carpi radialis brevis . Inspection of the tendon’s superficial surface usually reveals gross alteration in the tendon .All fibrous and granulation tissue is excised sharply and removed . A small opening is made in the synovial membrane if one is not already present, so that the lateral compartment of the joint can be inspected . If excess or abnormal synovial fluid is