肘关节镜结合小切口清理修补术根治顽固性网球肘

目的 :探究关节镜结合小切口清理修补术根治顽固性网球肘的临床疗效和肘部关节镜技术的提升效应。方法:自2014年3月至2017年2月连续收治顽固性网球肘患者36例(36肘),均采用关节镜结合小切口开放清理修补,两种方式交替进行,在核心操作上,前18例A组,男8例,女12例,年龄(43.89±9.71)岁,保守治疗时间(17.39±10.53)个月]直视下操作关节镜下验证,后18例B组,男7例,女11例,年龄(44.28±8.04)岁,保守治疗时间(15.50±9.18)个月],关节镜下操作直视下验证。术中观察镜下及大体病理表现,术后观察患者神经血管并发症,对比两组手术时间。患者术前术后随访时进行VAS评分和Mayo功能评分比较疗效。结果:所有患者获随访,随访时间A组(17.22±8.47)个月,B组(17.83±8.83)个月。无感染,有1例神经损伤。VAS评分,A组术前4.33±1.24,术后0.61±0.70;B组术前4.50±1.47,术后0.67±0.69;Mayo功能评分,A组术前62.22±7.90,术后93.06±5.18;B组术前61.94±8.93,术后92.22±5.21;术后评分均优于术前;组间VAS评分和Mayo功能评分比较差异无统计学意义。手术时间,B组(54.06±8.43)min小于A组(73.39±12.78)min。32例对治疗结果非常满意,3例对治疗结果满意,1例对治疗结果不满意,导致患者不满意的主要原因为神经损伤。结论:肘关节镜结合小切口清理修补术结合传统切开与关节镜手术的优势,为顽固性网球肘患者带来根治的治疗效果;此种术式适合致力于尝试探索及提升肘关节镜技术。

Treatment of obstinate tennis elbow by debridement and repair under elbow arthroscopy combined with small incision

Objective: To evaluate the effectivity and the improvement of elbow arthroscopic techniques of treating obstinate tennis elbow using debridement and repair under elbow arthroscopy combined with small incision.Methods: From March 2014 to February 2017,36 patients(total 36 elbows) with obstinate tennis elbow were treated consecutively using debridement and repair under elbow arthroscopy combined with small incision open,the two methods alternate. In key process,the first 18 casesgroup A including 8 males and 12 females with an average age of (43.89±9.71) years old,the treatment time was(17.39±10.53) months] used direct-looking operation and arthroscopic verification,the latter 18 casesgroup B including 7 males and 11 females with an averave age of (44.28±8.04) years old,the treatment time was(15.50±9.18) months] used arthroscopic operation and direct-looking verification. The arthroscopic and gross pathological findings were observed during the operation. After operation serious neurovascular complications were observed. The operation time was compared between two groups. MEPS (Mayo Elbow Performance Score) and VAS scores were recorded preoperatively and postoperatively.Results: All patients were followed up for an average of (17.22±8.47) months in group A and (17.83±8.83) months in group B. There was 1 case of nerve injury without infection. VAS score was improved from preoperative 4.33±1.24 to postoperative 0.61±0.70 in group A,and from 4.50±1.47 to postoperative 0.67±0.69 in group B. MEPS of group A was improved from preoperative 62.22±7.90 to postoperative 93.06±5.18 in group A,and from preoperative 61.94±8.93 to postoperative 92.22±5.21 in group B. There were no statistical differences between two groups in MEPS and VAS score. The operation time in group B(54.06±8.43) min was less than that in group A(73.39±12.78) min. Thirty-two cases were satisfied greatly with treatment results,3 cases satisfied,1 case unsatisfied. The main reasons that results in dissatisfaction were nerve injury.Conclusion: Treating obstinate tennis elbow using debridement and repair under elbow arthroscopy combined with small incision have open and arthroscopic surgery advantages,with thorough therapeutic effect. The procedure is suitable to try to explore and improve the elbow arthroscopic technique.