顽固性肱骨外上髁炎的外科治疗

目的探讨顽固性肱骨外上髁炎的手术治疗效果。方法2007年1月至2009年12月，我科采用局部麻醉下Nirschl改良手术治疗顽固性肱骨外上髁炎21例，术后通过VAS疼痛评分和Nirschl＆Pettrone分级评估患肘疼痛和功能改善情况。结果21例患者平均随访时问23．6个月。VAS疼痛评分术前休息时为6．21，日常活动时7．10，体育活动时8．76；术后休息时为0．83，日常活动时1．46，体育活动时2．22。术前、术后两者比较差异均有统计学意义。术后Nirschl＆Pettrone肘关节功能分级优13例，良7例，中1例，优良率95．2％。1例患者术后出现肘关节囊壁破裂后关节滑液积聚形成的皮下囊性肿胀，局部麻醉下行关节囊修复后肿胀消失。结论外科治疗顽固性肱骨外上髁炎可以有效改善肘关节疼痛和恢复关节活动，手术效果好。

Surgical treatment of refractory lateral epicondylitis

Objective To evaluate the clinical efficacy of surgical treatment for refractory lateral epicondylitis. Methods The modified Nirschl procedure was performed under local anesthesia in 21 patients with refractory lateral epicondylitis from January,2007 to December,2009 in our hospital. A visual analog scale（VAS） scoring was used to evaluate the degree of pain pre -and post -treatment. Elbow function was evaluated with Nirschl ＆ Pettrone grading system. Results Twenty - one patients underwent open surgical treatment for chronic refractory lateral epicondylitis. The average follow - up was 23.6 months. The preoperative VAS scores of pain were an average of 6.21 at rest,7.10 at daily activities, and 8.76 at sports or occupational activities. After surgery, the VAS scores were improved significantly ： 0.83 at rest, 1.46 at daily activities, and 2.22 at sports or occupational activities. According to the grading system by Nirschl ＆ Pettrone,the elbow function was excellent in t3 cases, good in 7 cases, and fair in one case. Twenty patients （ 95.2% ） achieved satisfactory results. One patient developed subcutaneous cystic mass（ n = 1 ）postoperatively due to the leakage of joint fluid,which was removed under local anesthesia. Conclusion The modified Nirschl procedure is effective for refractory lateral epicondylitis.