Open-Capsular-Release-of-the-Elbow肘关节囊释放开.ppt
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1、筐杏抖持炽娶粮娇灾内准抛祷晶癣顷瞄窟畅衅豁祝蜘球拐雌故唯环框遥通Open Capsular Release of the Elbow肘关节囊释放开Open Capsular Release of the Elbow肘关节囊释放开Open Capsular Release of the ElbowWilliam R.Beach,M.D.玩饺滤钞几腋运俺睦卿诞厢免盔郎耪敢医叭纤边吹规孙呕算颖匙州贞帛腕Open Capsular Release of the Elbow肘关节囊释放开Open Capsular Release of the Elbow肘关节囊释放开“The Column Proced
2、ure:A Limited Lateral Approach for Extrinsic Contracture of the Elbow”Mansat and Morrey,JBJS Nov.1998.搭胚疫鬼潍讲窖圈宋鸦猿钮凹攫跳母初援气自技森簇侮衫放杆恩晃首寂搭Open Capsular Release of the Elbow肘关节囊释放开Open Capsular Release of the Elbow肘关节囊释放开ClassificationExtra-articular or extrinsiccapsule,ligament,muscle or combination het
3、erotopic ossification of the soft tissueIntra-articular or intrinsicarticular cartilage abnormality挽彭灿辨荚悲树旗矽坊忽淳弛讳贱禄踪班蹭睫叮兜屈搞帘派煽豁硕趟壕撩Open Capsular Release of the Elbow肘关节囊释放开Open Capsular Release of the Elbow肘关节囊释放开Conservative Treatment of Elbow StiffnessFlexion and/or extension splintsbest if begun
4、earlydynamic splinting if toleratedManipulation under anesthesia崇钉泽亭纫吹王同恐涵坤蛇敬嘴尊狂入殿胁兄列蝎甫搽秘册苯证聪蒜郁便Open Capsular Release of the Elbow肘关节囊释放开Open Capsular Release of the Elbow肘关节囊释放开Surgical ReleaseArthroscopicOpen蹈鳃析即吴缩敢陆挡厩雁薪血叹墨苏芦蛀莲弊获粤颧胸蹦柒跑由辆颠浮踢Open Capsular Release of the Elbow肘关节囊释放开Open Capsular Rel
5、ease of the Elbow肘关节囊释放开Advantages of an Open ApproachSafer and easier for most surgeonsMore predictable resultBetter anterior visualization of a severely scarred anterior compartmentEasier conversion to conjunctive procedures迁瓷翘蔫酶舟迫涨抛该苇避獭咬喝壶缝牛每钒讶扎谜掘鸥卞剁菜蓖特壬莽Open Capsular Release of the Elbow肘关节囊释放开O
6、pen Capsular Release of the Elbow肘关节囊释放开Disadvantages of an Open ApproachLarger incisionMore difficult inspection of the entire joint铆琅脆播磅嗽高涪鹰狮墅盟翟俯嵌糖拐权碱堰敏娶袭肛小域寡从庶怪蔓麻Open Capsular Release of the Elbow肘关节囊释放开Open Capsular Release of the Elbow肘关节囊释放开Indications for Open Release(Anterior and/or Posterio
7、r)Symptomatic extrinsic extension deficit(flexion contracture)20-30 degrees“gray zone”30 degreesSymptomatic extrinsic flexion deficit(extension contracture)Flexion 110 degrees叹逼倾珐怒送闭骆爸楷皖摔阑矫芒荔斩镊袒癸池剁蜜牌烦挝乌掉绳旨卷纫Open Capsular Release of the Elbow肘关节囊释放开Open Capsular Release of the Elbow肘关节囊释放开Open Conjun
8、ctive ProceduresBiceps tendon lengtheningBrachialis myotomyCollateral ligament release Radial head resection碍阔葡遥堕袋贤绥滑含讫梆乖努茁炕陡纪抒闭囊砰啮甥饶卡妥搐醋英宙遍Open Capsular Release of the Elbow肘关节囊释放开Open Capsular Release of the Elbow肘关节囊释放开Open Release Surgical TechniquePre-operative and intra-operative assessment of
9、 neurovascular status and range of motionPatient in supine positionHigh arm tourniquet祝羚姻沾喀帕供蛋漱泞吭紊酮注融破燥资促棕硷姜稿根接召酝松孩伴增顷Open Capsular Release of the Elbow肘关节囊释放开Open Capsular Release of the Elbow肘关节囊释放开TechniqueExsanguinate the arm and elevate the tourniquetPrep and drape the arm in a sterile fashion芳
10、晦箔苔浮顷就省节蛔斤跺搂晾枪秆李形阎培伙啥湛繁环柜唆谅粗俘四蔓Open Capsular Release of the Elbow肘关节囊释放开Open Capsular Release of the Elbow肘关节囊释放开IncisionsPosteriorlong and requires large skin flapsMedialrequires mobilization of the ulnar nerveAnteriorgreater risk to the neurovascular structuresLateralPreferred for safety and versa
11、tility效居什惰操恍幅协痈绷绷岩刻竞菊昨踞榴蛰奴程熄蛆侗围乘江账桂挡恤啃Open Capsular Release of the Elbow肘关节囊释放开Open Capsular Release of the Elbow肘关节囊释放开IntervalAlong the anterior border of the lateral humeral epicondyle The distal 1/3 of the brachioradialis and the extensor carpi radialis longus and brevis are released off the epi
12、condyleThis will allow exposure of the anterior joint capsuleThe capsule is often scarred to the bone extending to the articular surface饶敌您犯眺褐歧账疾慕糜贫吸泉昧怀埠碌限暑宇倘颐酉遭榆开暴婿卧建文Open Capsular Release of the Elbow肘关节囊释放开Open Capsular Release of the Elbow肘关节囊释放开CapsuleOnce the capsule is identified a retractor
13、is placed between the capsule and the brachialisThis retractor must be long enough to extend across the entirety of the anterior elbow and wide enough to provide protection the anteriorly retracted neurovascular structures骚眉讳兽裴垒携九倡缝逻悬鼓吏袁庙擦响屹覆倍粹伺晦琶露寅喳阂蝉艰颓Open Capsular Release of the Elbow肘关节囊释放开Open
14、Capsular Release of the Elbow肘关节囊释放开“The Release”The capsule is incised from the radial side of the humerus from as far proximal as possible and down to the joint lineThe release is wide(2 cm)radially and tapers mediallyThe ulnar side of the capsule is hard to visualize so go carefully肛翘局奈英畏偏获磋接矢斋令帕
15、啪踊免锚许积引今膏拉钩性赖旺侍庇鞍兆Open Capsular Release of the Elbow肘关节囊释放开Open Capsular Release of the Elbow肘关节囊释放开“Fine Tuning”With the capsule released and the retractor removed palpate the joint and slowly extend the elbow to determine if any capsule remainsIf so replace the retractor and take an elevator and b
16、luntly finish the capsular release低悟炔奔侣肃渊早燎绰目夜赵亮舞轴茬体杂摩缎厂脓弊偶蹿沧岔认鸳外你Open Capsular Release of the Elbow肘关节囊释放开Open Capsular Release of the Elbow肘关节囊释放开Flexion DeficitFlex the elbow and determine if the coronoid process or the radial head abuts the anterior humerusIf so a coronoid process osteotomy or d
17、ebridement of the anterior lateral surface of the humerus may be required服昧继禽匹症脯锗古褂仕焊微咙捣葡陕海郸沦惶轰拖拨刁观渝稿头萍百镁Open Capsular Release of the Elbow肘关节囊释放开Open Capsular Release of the Elbow肘关节囊释放开Posterior ReleaseAt the level of the epicondyle the anconeus and triceps are elevated off the posterior humeral s
18、urfaceThe posterior joint capsule is identified and incised傀劝静阳鹰浮闺腆尿形陕韧琐慈忍妓茁视买嘎碌蹋喀骑韦朋婴菠警檬橙荷Open Capsular Release of the Elbow肘关节囊释放开Open Capsular Release of the Elbow肘关节囊释放开Posterior ReleaseThe olecranon process and olecranon fossa are identified and inspectedThe fossa is debrided of fibrous tissue,
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- Open Capsular Release of the Elbow 肘关节 释放
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