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1、谁在做肘关节手术? l手外科医生 l上肢外科医生 l关节镜外科医生 l 普通骨科医生 肘关节外科手术 l远端二头肌腱撕裂 l肱骨外上髁炎（网球肘） l内外侧副韧带撕裂 Click to edit Master subtitle style * 3 Click to edit Master title style 远端二头肌腱撕脱 Biceps Tendon Attachment Site Distal Biceps Attachment Biceps Tendon Attachment Distal Biceps Tendon Biceps Distal Biceps Tendon Ruptu
2、re 肱骨内侧髁 尺骨茎突 撕裂的二头肌腱 常见于中年男性的 dominant手 Biceps Tendon Reattachment 2 Incision Technique Drill Holes Biceps Tendon Reattachment Single Incision Suture Anchors Suture Anchor Technique l1 incisionLess risk of infection & less scarring lNo risk of bone tunnel breakage lEasier to perform, saves OR time.
3、 JHS- May 2003 Click to edit Master subtitle style * 11 Click to edit Master title style肱骨外上髁炎 l网球肘 外上髁炎 损伤 & 治疗 lECRB桡侧腕短伸肌的小损伤, 非感染性 l手术治疗不常用 (报道4-8% 的病例用手术治疗) l外科手术 开放或镜下松解(shaver or RF) 松解，重连接 Lateral Elbow 桡骨 肱骨外上髁 尺骨 Location of ECRB ECRL 桡侧腕长伸肌 ECRB 桡侧腕短伸肌 ECU Extensor Carpi Ulnaris尺侧腕伸肌 ECRB
4、 Location Continued Mitek Technique Brochure (Dr. Lorenzo Walker Cat # 900091) l找到ECRB l松解ECRB lResect Lateral Epicondyle & expose raw cancellous surface lMobilize Extensor Origin l用2个Mitek 锚钉 (GII, Fastin)重新连接到外上 髁 Click to edit Master subtitle style * 17 Click to edit Master title style内侧副韧带修复 lTo
5、mmy John Surgery (Medial UCL) 侧副韧带修复 Medial UCL Complex 斜束 前束 后束 Medial UCL: Anterior Band A Pitchers Injury “Tommy John Surgery” lNamed after the first patient of ulnar collateral replacement surgery. lDoctors name: Frank Jobe lFirst surgery done in 1974 When the Rupture Occurs l l Late-cockingLate
6、-cocking l l AccelerationAcceleration 尺侧副韧带撕裂相关问题 l过头投掷运动时缺乏稳定性 l在做过头投掷运动时手臂不能用力 l过头投掷运动时不能控制 传统UCL的修复 l“金标准” l骨隧道技术 l前臂掌长肌腱或跟腱做韧带移 植 l尺神经转置 l移植物8字固定 l韧带端用缝线缝合在一起 Repair of UCL l方法复杂，费时 l可用带线锚钉固定 l简化手术 &省时 l减少骨隧道穿肌腱造成的创 伤 Click to edit Master subtitle style * 24 Click to edit Master title styleAncho
7、rs for the Elbow Anchor Body:2.4 x 8.8mm Arc Range:7.8mm Drill Hole Size:2.4 x 14.2mm Suture:#2 Ethibond & CP-2 Reverse Cut Needle #2 Panacryl & CP-2 Reverse Cut Needle Anchor Material:Titanium body with Nitinol Arcs Pullout lbs.: 25 lbs Indications:Foot: Lateral & medial ankle instability, Mid- foo
8、t reconstruction, Hallux Valgus & Achillies tendon repair Elbow: Tennis Elbow, Biceps Tendon Hand: Thumb UCL and Scapholunate GII Anchor Anchor Body:4.1 x 6.0 mm Drill Hole Size:3.5 x 18 mm Suture:#2 Ethibond & CP-2 Reverse Cut Needle #2 Panacryl & CP-2 Reverse Cut Needle Anchor Material:PLA Pullout
9、 lbs.: 35 lbs Indications:Elbow: Biceps tendon reattachment Ankle: Achilles tendon repair, Lateral stabilization, Medial stabilization at the medial talus site Panalok Anchor Anchor Body:3.0 x 8.4 mm 4.0 x 9.7 mm Suture:#2 Ethibond (no needles) Drill bit:Self drilling Anchor Material:Titanium Pullout lbs.:33.5 lbs (for 3.0mm), 61 lbs (4.0mm) Indications:Foot: Midfoot reconstruction, Medial or lateral instability, Achilles tendon, Hallux valgus. Elbow: Tennis elbow, Biceps tendon Hand: Scapholunate ligament, Ulnar or radial collateral ligament Fastin 3.0 or 4.0 Anchor