改良Nirschl术式治疗顽固性肱骨外上髁炎

Treatment of refractory lateral epicondylitis with modified Nirschl surgical technique

目的:探讨改良Nirschl术式治疗顽固性肱骨外上髁炎的临床疗效。方法:2009年3月至2011年1月,共收治顽固性单纯肱骨外上髁炎21例(21肘),男8例,女13例;年龄25～59岁,平均(48.3±13.4)岁;优势侧16例,非优势侧5例。发病时间8～33个月,平均(17.1±7.7)个月,患者均接受过多种非手术治疗。采用小切口下桡侧腕短伸肌腱起点清理术,即改良Nirschl术式进行治疗,病变涉及指总伸肌腱者予以指总伸肌腱病变部分切除。术后切口部位冰敷2d,石膏托行肘关节制动1周后开始肘部力量和活动度锻炼,腕关节制动2周后行手部和腕部活动度和力量锻炼及正常日常活动。术后随访记录患者休息疼痛情况、手部握力和患者满意度,根据Verhaar网球肘疗效评分评价恢复情况。结果:21例失访4例,17例术后获得随访,时间13～22个月,平均16.3个月。根据Verhaar网球肘疗效评价,结果优15例,良2例,无肘关节不稳定等并发症出现。结论:单纯顽固性肱骨外上髁炎可通过行改良Nirschl术式取得良好疗效,其关键在于对并发疾病的排除和准确诊断,以及术中病变组织准确切除。

Objective ：To investigate the clinical effects of modified Nirschl surgical technique in treating refractory lateral epicondylitis. Methods：From March 2009 to January 2011,21 patients （21 elbows） with refractory lateral epicondylitis were treated in our hospital There were 8 males and 13 females ,ranged in age from 25 to 59 years with an average of （48.3：t： 13.4） years and the duration time from 8 to 33 months with an average of （17.1＋7.7） months;affected position in dominant sides of 16 cases and non-dominant sides of 5 cases. The patients had already received multiple non-operative treatments. Mod- ified Nirschl surgical technique was performed, and operative origination from origin of musculus extensor carpi radialis brevis to discard process with small incision, the process place of extensor digitorum communis would be removed. The incisions were nursed by ice compress for 2 days after operation. Range of motion （ROM） and strengthening exercise of elbow joints started at the 1 week after plaster slab fixation ; ROM and strengthening exercise of wrist joints also started at the 2 week after fixation. The pain, power of gripping and patient staisfaction were recorded after operation. Verhaar scaling were used to estimate the re- covery. Results：Seventeen patients were followed up from 13 to 22 months with an average of 16.3 months. According to Ver- haar standard, 15 cases obtained excellent results and 2 good. No postoperative complication such as instability was found. Conclusion：Modified Nirschl surgical technique is an effective method in treating refractory lateral epicondylitis but correct to diagnosis and exclusion the coexisting diseases, accurate removal the process are important guarantee.