关节镜下手术治疗顽固性网球肘合并退变性尺骨外侧副韧带损伤的疗效

Efficacy of arthroscopic surgical treatment for recalcitrant tennis elbow combined with degenerative lateral ulnar collateral ligament lesions

目的探讨关节镜下手术治疗顽固性网球肘合并退变性尺骨外侧副韧带(LUCL)损伤的效果。方法采用回顾性病例系列研究分析2014年6月至2020年12月北京积水潭医院收治的27例顽固性网球肘合并退变性LUCL损伤患者的临床资料,其中男19例,女8例;年龄39~56岁[(49.8±6.9)岁]。患者均在关节镜下确认合并退变性LUCL损伤,并行关节镜下LUCL清理及固缩结合桡侧腕短伸肌(ECRB)修补治疗。记录手术时间、术中出血量、住院时间。比较术前及术后1年视觉模拟评分(VAS)、Mayo肘关节功能评分(MEPS)、患者计量网球肘(PRTEE)评分、上肢功能评定表(DASH)评分。观察并发症情况。结果患者均获随访12~73个月[(24.1±9.7)个月]。手术时间为0.75~1 h[(0.8±0.2)h];术中出血量为5~10 ml[(7.2±1.5)ml];住院时间为4~12 d[(6.2±2.1)d]。术前VAS、MEPS、PRTEE评分、DASH评分分别为5(3,6)分、70(65,85)分、47(42,62)分、43.8(36.8,49.0)分,术后1年分别为1(1,2)分、95(85,100)分、8(6,12)分、12.9(8.9,15.8)分(P均<0.01)。所有患者术后无肘关节活动受限、伤口感染、异位骨化、创伤性关节炎等并发症。结论对于顽固性网球肘合并退变性LUCL损伤,关节镜下LUCL清创及固缩结合ECRB修补治疗可缓解疼痛、促进肘关节功能恢复。

Objective To evaluate the outcome of arthroscopic surgical treatment for recalcitrant tennis elbow combined with degenerative lateral ulnar collateral ligament(LUCL)lesions.Methods A retrospective case series study was made on clinical data of 27 patients with recalcitrant tennis elbow combined with degenerative LUCL lesions admitted to Beijing Jishuitan Hospital from June 2014 to December 2020.There were 19 males and 8 females,with the age range of 39-56 years[(49.8±6.9)years].The degenerative LUCL lesions were evaluated arthroscopically.Arthroscopic LUCL debridement and shrinkage combined with repair of extensor carpi radialis brevis(ECRB)were performed in all patients.The operation time,intraoperative bleeding volume and length of hospital stay were recorded.The visual analogue scale(VAS),Mayo elbow performance score(MEPS),patient-rated tennis elbow evaluation(PRTEE)scale,and disability of the arm,shoulder and hand(DASH)questionnaire were evaluated and compared preoperatively and at the final follow-up.Results All patients were followed up for 12-73 months[(24.1±9.7)months],with the operation time of 0.75-1 hours[(0.8±0.2)hours],intraoperative bleeding volume of 5-10 ml[(7.2±1.5)ml],and length of hospital stay of 4-12 days[(6.2±2.1)days].The VAS,MEPS,PRTEE and DASH scores were significantly improved at postoperative 1 year[1(1,2)points,95(85,100)points,8(6,12)points and 12.9(8.9,15.8)points]when compared with those preoperatively[5(3,6)points,70(65,85)points,47(42,62)points and 43.8(36.8,49.0)points](all P<0.01).No patients had limited range of motion,wound infection,heterotopic ossification,traumatic arthritis and other complications.Conclusion For recalcitrant tennis elbow combined with degenerative LUCL lesions,arthroscopic LUCL debridement and shrinkage combined with ECRB repair can achieve pain relief and elbow function recovery.