网球肘松解术
Patients › Elbow
Tennis elbow release surgery — for persistent pain despite physiotherapy and other conservative treatments.
为何建议进行此手术
网球肘是一种常见的疾病，表现为肘部外侧的肌腱出现疼痛和炎症。大多数患者在6个月至1年内无需手术即可康复，约90%的患者在一年内症状可自行缓解。由于外科医生无法预测哪些患者能够自愈，因此通常建议首先尝试非手术治疗。
您的外科医生建议进行此手术，是因为您存在持续性症状，且标准治疗未能改善。该手术涉及做一个小的切口，以松解导致您疼痛的紧张肌腱。此手术专为对其他方法无反应的小部分患者设计。主要目标是提供持久的疼痛缓解，并帮助您恢复正常活动。
手术前
大多数网球肘患者无需手术即可康复，因此您的外科医生可能会建议先尝试非手术治疗。您可能需要进行X光或MRI检查以评估肘部，或进行血液检查以确保您适合该手术。请按照外科医生的指示在手术前禁食，并停止服用某些药物。安排专人开车送您回家，并携带一份您目前服用的所有药物清单。就诊时请穿着舒适的衣物。您的外科医生将在疼痛区域上方做一个单一切口，进行开放手术。
手术当天
您将抵达医院，并与您的外科医生和麻醉师会面。在前往手术室之前，他们将评估您的健康状况并回答您提出的任何问题。本手术将在全身麻醉下进行。手术期间您将完全处于睡眠状态。部分患者可能还会接受区域神经阻滞以缓解术后疼痛；麻醉师将根据您的具体情况在当天决定是否需要。
您的外科医生将在手术部位做一个常规的单一切口以进行松解。手术过程本身较为短暂，随着麻醉效果消退，您将在复苏区醒来。您将在该区域短暂休息，护理团队将确认您感觉舒适且生命体征稳定后，方可出院回家。
手术过程
您的外科医生将在肘部外侧做一个切口。这是一种开放入路，意味着医生通过这一个切口直接进行操作，而不是使用小型关节镜摄像头。他们会仔细分离组织，以到达引起您疼痛的肌腱。
在手术内部，您的外科医生将移除肌腱附着于骨骼处的受损部分。他们可能还会轻轻刮除骨面，以促进愈合。这个过程称为松解术。它移除了不再正常工作的磨损组织。一旦受损区域被清除，您的外科医生会用缝线或医用胶闭合切口。
该手术仅针对肌腱磨损的具体部位。您的外科医生无需为此松解术使用特殊的锚钉或螺钉。他们只需移除病变组织，让身体自行完成其余的愈合过程。这种直接入路使他们能够清楚地看到需要修复的确切位置。
术后
您将在复苏室苏醒。您的外科医生会在您的肘部使用一个常规切口。您的手臂上会覆盖敷料，并佩戴吊带或支具。疼痛将通过标准药物进行管理。这通常是一个日间手术，因此您预计可以在当天回家，尽管偶尔患者需要过夜住院。您必须有人在最初的24小时内陪伴您，以帮助您。大多数患者会很快感觉好转，但完全恢复可能需要长达12到18个月的时间。
恢复
大多数网球肘患者的症状会在一年内自行消退。您的身体具有稳定的愈合节律，疼痛通常在三到四个月内缓解。由于大多数人的恢复是自然发生的，手术通常仅保留给那些通过休息和理疗未能改善的患者。如果您接受手术，您可以预期对结果有接近90%的满意度。
开放手术后，您的肘部痛点处会有一个单一的小切口。在最初几天，您可能会在该区域周围感到一些肿胀和不适。您的外科医生将指导您如何使用吊带或支具在休息时保护手臂。您可能需要睡觉时将手臂稍微抬高，以帮助减轻肿胀。
随着肿胀消退，您将开始与物理治疗师进行轻柔的活动练习。您将专注于恢复力量和活动范围，同时避免拉伤正在愈合的肌腱。您的外科医生会告知您何时可以安全地恢复驾驶或提举等日常活动。您的具体恢复时间表可能与他人不同，因此请密切遵循您的外科医生和物理治疗团队的建议。
可能发生的问题
大多数患者恢复良好，但偶尔也会出现一些问题。您的外科医生和医疗团队会密切监测您，以便尽早发现任何异常。
有时，术后外侧肘部的疼痛不会消失。如果您在手术前接受过多次注射，这种情况更有可能发生。如果症状没有改善，请在下次复查时告知您的外科医生。
开放性手术存在感染的风险。您可能会注意到切口周围出现红肿、发热或肿胀加重。如果出现这些迹象，请立即致电诊所以便接受治疗。
极少数情况下，手术效果可能不够理想，日后可能需要再次手术。这种情况并不常见，但如果您的疼痛随时间推移复发或加重，请告知您的外科医生。
您的外科医生采用开放性手术入路，在肘部做一个单一切口。虽然存在其他方法，但这种特定技术与其他手术方式相比，并发症风险相似。
本页面中的并发症表格列出了典型的发生率，如需具体数据，请参阅该表格。
何时联系我们
如果您出现发热、伤口红肿加重或渗出，请立即联系我们。如突发剧烈疼痛、小腿肿胀或呼吸困难，请立即前往急诊。如果您感觉手臂麻木或无法活动，请立即联系我们。大多数网球肘病例可在6个月内无需手术而自行缓解。然而，如果症状未改善或加重，我们需要为您就诊。
Evidence & references
Anatomy & Pathophysiology
- The pathologic tissue in tennis elbow involves the undersurface of the extensor carpi radialis brevis tendon [1].
- The origin of the extensor carpi radialis brevis is visualized during arthroscopic tennis elbow release [1].
- Decortication of the lateral epicondyle and lateral epicondylar ridge is performed to address pathologic tendinous attachment [1].
- Undersurface tears of the extensor carpi radialis brevis are a finding in tennis elbow release procedures [1].
- Medial capsular injury may occur and allow excessive fluid extravasation during arthroscopic elbow procedures [1].
- A 30-degree arthroscope is adequate to view around the corner for most of the arthroscopic tennis elbow release procedure [1].
- A 70-degree arthroscope may be required in rare instances during arthroscopic tennis elbow release [1].
- The proximal medial or superomedial portal is located approximately 2 cm proximal to the medial epicondyle and 1 cm anterior to the intermuscular septum [1].
- The trocar and sheath for the proximal medial or superomedial portal are introduced anterior to the intermuscular septum [1].
- The trocar is directed toward the radial head while maintaining contact with the anterior aspect of the humerus [1].
- The superolateral portal is established with an 18-gauge needle through the lesion [1].
- Debridement of the capsule and pathologic tendinous attachment of the extensor carpi radialis brevis is performed using a curet and motorized shaver [1].
- Decortication of the lateral epicondyle can be done with an arthroscopic burr, handheld instruments, or electrocautery [1].
Treatment
- Arthroscopic tennis elbow release is described as technique 52.39 [1].
- The patient is placed prone on the operating table after intubation [1].
- Two rolled towels are placed longitudinally under the patient's thorax [1].
- All bony prominences are padded well [1].
- The affected extremity is positioned with the ipsilateral shoulder abducted to 90 degrees [1].
- The arm is supported with a precut foam holder [1].
- Anatomic landmarks and portal sites are marked prior to the procedure [1].
- The joint is distended with 20 to 30 mL of saline through an 18-gauge needle introduced through the direct lateral portal [1].
- The proximal medial or superomedial portal is established approximately 2 cm proximal to the medial epicondyle and 1 cm anterior to the intermuscular septum [1].
- The trocar and sheath are introduced anterior to the intermuscular septum [1].
- Contact with the anterior aspect of the humerus is maintained at all times as the trocar is directed toward the radial head [1].
- A 2.7-mm, 30-degree arthroscope is inserted into the joint to perform the diagnostic portion of the procedure [1].
- The superolateral portal is established with an 18-gauge needle through the lesion after pathologic tissue is identified [1].
- A full-radius resector is used to excise the capsule to identify the undersurface of the extensor carpi radialis brevis tendon [1].
- The origin of the extensor carpi radialis brevis is viewed [1].
- A curet and motorized shaver are used to debride the capsule and the pathologic tendinous attachment of the extensor carpi radialis brevis [1].
- The lateral epicondyle is decorticated [1].
- Decortication of the lateral epicondyle and lateral epicondylar ridge can be performed with an arthroscopic burr, handheld instruments, or electrocautery [1].
- A 30-degree arthroscope is adequate to view around the corner for most of the procedure [1].
- A 70-degree arthroscope may be required in rare instances [1].
- Limited internal fixation can be accomplished with cannulated screws when medial capsular injury has not occurred [1].
- The benefit of arthroscopy is outweighed by associated risks in more extensive fractures involving significant soft-tissue injuries [1].
- One should be fully prepared to abort the procedure when visualization is poor or fluid extravasation is significant [1].
References
[1] Campbell S Operative Orthopaedics 4 Volume Set. ARTHROSCOPIC REPAIR OF POSTERIOR HUMERAL AVULSION OF THE GLENOHUMERAL LIGAMENT > ARTHROSCOPIC TENNIS ELBOW RELEASE.
