open capsular release of the elbow肘敏关节囊释放开.pptVIP

Open Capsular Release of the Elbow William R. Beach, M.D. “The Column Procedure: A Limited Lateral Approach for Extrinsic Contracture of the Elbow” Mansat and Morrey, JBJS Nov. 1998. Classification Extra-articular or extrinsic capsule, ligament, muscle or combination heterotopic ossification of the soft tissue Intra-articular or intrinsic articular cartilage abnormality Conservative Treatment of Elbow Stiffness Flexion and/or extension splints best if begun early dynamic splinting if tolerated Manipulation under anesthesia Surgical Release Arthroscopic Open Advantages of an Open Approach Safer and easier for most surgeons More predictable result Better anterior visualization of a severely scarred anterior compartment Easier conversion to conjunctive procedures Disadvantages of an Open Approach Larger incision More difficult inspection of the entire joint Indications for Open Release (Anterior and/or Posterior) Symptomatic extrinsic extension deficit (flexion contracture) 20-30 degrees “gray zone” 30 degrees Symptomatic extrinsic flexion deficit (extension contracture) Flexion 110 degrees Open Conjunctive Procedures Biceps tendon lengthening Brachialis myotomy Collateral ligament release Radial head resection Open Release Surgical Technique Pre-operative and intra-operative assessment of neurovascular status and range of motion Patient in supine position High arm tourniquet Technique Exsanguinate the arm and elevate the tourniquet Prep and drape the arm in a sterile fashion Incisions Posterior long and requires large skin flaps Medial requires mobilization of the ulnar nerve Anterior greater risk to the neurovascular structures Lateral Preferred for safety and versatility Interval Along 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 epicondyle This will allow exposure of the anterior joint capsule The capsule is often scarred to the bone extendin