伸肌腱止點清理帶線錨釘修復治療頑固性網球肘的近期療效_《中國修復重建外科雜志》

作者：

鄧銀栓 ^1# , 唐康來 ¹ , 李輝 ¹ , 張吉強 ² , 謝美明 ¹ , 曹洪輝 ¹ , 陳艷 ¹ , 陳磊 ¹ , 周兵華 ¹ , 譚曉康 ¹ , 許建中 ¹

1 第三軍醫大學西南醫院骨科全軍矯形外科中心（重慶，400038）;;
2第三軍醫大學基礎醫學院神經生物學教研室重慶市神經生物學重點實驗室 #現在蘭州軍區蘭州總醫院骨科全軍創傷骨科研究所;

關鍵詞：

頑固性網球肘橈側腕短伸肌指伸肌帶線錨釘修復

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目的探討伸肌腱止點清理帶線錨釘修復橈側腕短伸肌（extensor carpi radialis brevis，ECRB）、指伸肌（extensor digitorum communis，EDC）治療頑固性網球肘的近期療效。方法2009年3月－2011年5月，采用伸肌腱止點清理帶線錨釘修復ECRB及EDC治療單側頑固性網球肘患者10例。男6例，女4例；年齡36～57歲，平均45.4歲。優勢肘8例，非優勢肘2例；重體力勞動者4例，普通工作者6例。病程8～24個月，平均12.3個月。患者均有肱骨外上髁部疼痛，局部腫脹壓痛，Mill征（+）。肘關節活動范圍：伸直0～30°，平均11.3°；屈曲120～145°，平均132.5°。MRI提示均為肱骨外髁炎。結果術后切口均Ⅰ期愈合，無感染、關節液外漏及肘關節強直等并發癥發生。10例均獲隨訪，隨訪時間4～23個月，平均12個月；其中7例隨訪12個月及以上者均未復發。重體力勞動者術后（3.75 ± 0.95）個月恢復原工作，與普通工作者（2.91 ± 0.20）個月比較，差異無統計學意義（t=1.715，P=0.180）。術后1、3個月及末次隨訪時疼痛視覺模擬評分（VAS）均較術前顯著下降（P lt; 0.05），Mayo評分均較術前顯著提高（P lt; 0.05）；優勢側及非優勢側握力均較術前顯著提高（P lt; 0.05），末次隨訪時與非手術側握力比較差異均無統計學意義（P gt; 0.05）。末次隨訪時肘關節活動范圍：伸直0～—10°，平均—1.5°；屈曲140～160°，平均150.5°。結論伸肌腱止點清理帶線錨釘修復ECRB及EDC治療頑固性網球肘，能有效防止前臂伸肌力量潛在丟失，且創傷小，疼痛緩解顯著，握力恢復接近正常，近期療效較好。

引用本文： 鄧銀栓,唐康來,李輝,張吉強,謝美明,曹洪輝,陳艷,陳磊,周兵華,譚曉康,許建中. 伸肌腱止點清理帶線錨釘修復治療頑固性網球肘的近期療效. 中國修復重建外科雜志, 2013, 27(1): 1-6. doi: 復制

1.	Behrens SB, Deren ME, Matson AP, et al. A review of modern management of lateral epicondylitis. Phys Sportsmed, 2012, 40(2): 34-40.
2.	Kotnis NA, Chiavaras MM, Harish S. Lateral epicondylitis and beyond: imaging of lateral elbow pain with clinical-radiologic correlation. Skeletal Radiol, 2012, 41(4): 369-386.
3.	Solheim E, Hegna J, ?yen J. Extensor tendon release in tennis elbow: results and prognostic factors in 80 elbows. Knee Surg Sports Traumatol Arthrosc, 2011, 19(6): 1023-1027.
4.	Walz DM, Newman JS, Konin GP, et al. Epicondylitis: pathogenesis, imaging, and treatment. Radiographics, 2010, 30(1): 167-184.
5.	Shiri R, Viikari-Juntura E. Lateral and medial epicondylitis: role of occupational factors. Best Pract Res Clin Rheumatol, 2011, 25(1): 43-57.
6.	Rhyou IH, Kim KW. Is posterior synovial plica excision necessary for refractory lateral epicondylitis of the elbow? Clin Orthop Relat Res, 2013, 471(1): 284-290.
7.	Wolf JM, Mountcastle S, Burks R, et al. Epidemiology of lateral and medial epicondylitis in a military population. Mil Med, 2010, 175(5): 336-339.
8.	Coleman B, Quinlan JF, Matheson JA. Surgical treatment for lateral epicondylitis: a long-term follow-up of results. J Shoulder Elbow Surg, 2010, 19(3): 363-367.
9.	Pruzansky ME, Gantsoudes GD, Watters N. Late surgical results of reattachment to bone in repair of chronic lateral epicondylitis. Am J Orthop (Belle Mead NJ), 2009, 38(6): 295-299.
10.	Karkhanis S, Frost A, Maffulli N. Operative management of tennis elbow: a quantitative review. Br Med Bull, 2008, 88(1): 171-188.
11.	Shiri R, Viikari-Juntura E, Varonen H, et al. Prevalence and determinants of lateral and medial epicondylitis: a population study. Am J Epidemiol, 2006, 164(11): 1065-1074.
12.	Lee BG, Cho NS, Rhee YG. Modified Mason-Allen suture bridge technique: a new suture bridge technique with improved tissue holding by the modified Mason-Allen stitch. Clin Orthop Surg, 2012, 4(3): 242-245.
13.	Fu SC, Rolf C, Cheuk YC, et al. Deciphering the pathogenesis of tendinopathy: a three-stages process. Sports Med Arthrosc Rehabil Ther Technol, 2010, 13(2): 30.
14.	李輝, 唐康來, 鄧銀栓, 等. 外源性前列腺素E2對兔跟腱膠原含量的影響. 中國修復重建外科雜志, 2012, 26(3): 352-358.
15.	Kumar S, Stanley D, Burke NG, et al. Tennis elbow. Ann R Coll Surg Engl, 2011, 93(6): 432-436.
16.	Bunata RE, Brown DS, Capelo R. Anatomic factors related to the cause of tennis elbow. J Bone Joint Surg (Am), 2007, 89(9): 1955-1963.
17.	Thornton SJ, Rogers JR, Prickett WD, et al. Treatment of recalcitrant lateral epicondylitis with suture anchor repair. Am J Sports Med, 2005, 33(10): 1558-1564.
18.	Rayan F, Rao VS, Purushothamdas S, et al. Common extensor origin release in recalcitrant lateral epicondylitis-role justified? J Orthop Surg Res, 2010, 5(1): 31.

1. Behrens SB, Deren ME, Matson AP, et al. A review of modern management of lateral epicondylitis. Phys Sportsmed, 2012, 40(2): 34-40.
2. Kotnis NA, Chiavaras MM, Harish S. Lateral epicondylitis and beyond: imaging of lateral elbow pain with clinical-radiologic correlation. Skeletal Radiol, 2012, 41(4): 369-386.
3. Solheim E, Hegna J, ?yen J. Extensor tendon release in tennis elbow: results and prognostic factors in 80 elbows. Knee Surg Sports Traumatol Arthrosc, 2011, 19(6): 1023-1027.
4. Walz DM, Newman JS, Konin GP, et al. Epicondylitis: pathogenesis, imaging, and treatment. Radiographics, 2010, 30(1): 167-184.
5. Shiri R, Viikari-Juntura E. Lateral and medial epicondylitis: role of occupational factors. Best Pract Res Clin Rheumatol, 2011, 25(1): 43-57.
6. Rhyou IH, Kim KW. Is posterior synovial plica excision necessary for refractory lateral epicondylitis of the elbow? Clin Orthop Relat Res, 2013, 471(1): 284-290.
7. Wolf JM, Mountcastle S, Burks R, et al. Epidemiology of lateral and medial epicondylitis in a military population. Mil Med, 2010, 175(5): 336-339.
8. Coleman B, Quinlan JF, Matheson JA. Surgical treatment for lateral epicondylitis: a long-term follow-up of results. J Shoulder Elbow Surg, 2010, 19(3): 363-367.
9. Pruzansky ME, Gantsoudes GD, Watters N. Late surgical results of reattachment to bone in repair of chronic lateral epicondylitis. Am J Orthop (Belle Mead NJ), 2009, 38(6): 295-299.
10. Karkhanis S, Frost A, Maffulli N. Operative management of tennis elbow: a quantitative review. Br Med Bull, 2008, 88(1): 171-188.
11. Shiri R, Viikari-Juntura E, Varonen H, et al. Prevalence and determinants of lateral and medial epicondylitis: a population study. Am J Epidemiol, 2006, 164(11): 1065-1074.
12. Lee BG, Cho NS, Rhee YG. Modified Mason-Allen suture bridge technique: a new suture bridge technique with improved tissue holding by the modified Mason-Allen stitch. Clin Orthop Surg, 2012, 4(3): 242-245.
13. Fu SC, Rolf C, Cheuk YC, et al. Deciphering the pathogenesis of tendinopathy: a three-stages process. Sports Med Arthrosc Rehabil Ther Technol, 2010, 13(2): 30.
14. 李輝, 唐康來, 鄧銀栓, 等. 外源性前列腺素E2對兔跟腱膠原含量的影響. 中國修復重建外科雜志, 2012, 26(3): 352-358.
15. Kumar S, Stanley D, Burke NG, et al. Tennis elbow. Ann R Coll Surg Engl, 2011, 93(6): 432-436.
16. Bunata RE, Brown DS, Capelo R. Anatomic factors related to the cause of tennis elbow. J Bone Joint Surg (Am), 2007, 89(9): 1955-1963.
17. Thornton SJ, Rogers JR, Prickett WD, et al. Treatment of recalcitrant lateral epicondylitis with suture anchor repair. Am J Sports Med, 2005, 33(10): 1558-1564.
18. Rayan F, Rao VS, Purushothamdas S, et al. Common extensor origin release in recalcitrant lateral epicondylitis-role justified? J Orthop Surg Res, 2010, 5(1): 31.

《中國修復重建外科雜志》

伸肌腱止點清理帶線錨釘修復治療頑固性網球肘的近期療效

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《中國修復重建外科雜志》

伸肌腱止點清理帶線錨釘修復治療頑固性網球肘的近期療效

摘要 全文 圖表 視頻 參考文獻 施引文獻 補充材料

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