OpenCapsularReleaseoftheElbow肘关节囊释放开.pptxVIP

OpenCapsularReleaseoftheElbow肘关节囊释放开第1页/共60页 ClassificationExtra-articular or extrinsiccapsule, ligament, muscle or combination heterotopic ossification of the soft tissueIntra-articular or intrinsicarticular cartilage abnormality第2页/共60页 Conservative Treatment of Elbow StiffnessFlexion and/or extension splintsbest if begun earlydynamic splinting if toleratedManipulation under anesthesia第3页/共60页 Surgical ReleaseArthroscopicOpen第4页/共60页 Advantages of an Open ApproachSafer and easier for most surgeonsMore predictable resultBetter anterior visualization of a severely scarred anterior compartmentEasier conversion to conjunctive procedures第5页/共60页 Disadvantages of an Open ApproachLarger incisionMore difficult inspection of the entire joint第6页/共60页 Indications for Open Release (Anterior and/or Posterior)Symptomatic extrinsic extension deficit (flexion contracture) 20-30 degrees “gray zone”30 degreesSymptomatic extrinsic flexion deficit (extension contracture)Flexion 110 degrees第7页/共60页 Open Conjunctive ProceduresBiceps tendon lengtheningBrachialis myotomyCollateral ligament release Radial head resection第8页/共60页 Open Release Surgical TechniquePre-operative and intra-operative assessment of neurovascular status and range of motionPatient in supine positionHigh arm tourniquet第9页/共60页 TechniqueExsanguinate the arm and elevate the tourniquetPrep and drape the arm in a sterile fashion第10页/共60页 IncisionsPosteriorlong and requires large skin flapsMedialrequires mobilization of the ulnar nerveAnteriorgreater risk to the neurovascular structuresLateralPreferred for safety and versatility第11页/共60页 IntervalAlong the anterior border of the lateral humeral epicondyle The distal 1/3 of the brachioradialis and the extensor carpi radialis longus and brevis are released off the epicondyleThis will allow exposure of the anterior joint capsuleThe capsule is often scarred to the bone extending to the articular surface第12页/共60页 CapsuleOnce the capsule is identified a retractor is placed betw