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中华肩肘外科电子杂志 ›› 2022, Vol. 10 ›› Issue (04) : 358 -362. doi: 10.3877/cma.j.issn.2095-5790.2022.04.012

病例报告

合并肱骨小头软骨损伤及骨间背侧神经卡压的顽固性网球肘一例的治疗体会
罗勇1, 尤田2,(), 白露2, 陈纳纳2, 张新涛2, 杨清均3, 卢文倩4, 李佳峒4, 黄显程3   
  1. 1. 515000 汕头大学医学院
    2. 518000 北京大学深圳医院运动医学科
    3. 261000 潍坊医学院临床医学系
    4. 518000 深圳大学医学院临床医学系
  • 收稿日期:2022-09-23 出版日期:2022-11-05
  • 通信作者: 尤田
  • 基金资助:
    深圳市科技计划项目(JCYJ20220530160218040); 深圳大学教学改革研究项目(JG2022165); 北京大学深圳医院临床研究项目(LCYJ2020005); 广东省体育局科技创新和体育文化发展科项目(GDSS2020N002); 广东省自然科学基金(2017A030310616); 广东省医学科学技术研究基金项目(A2017202)
  • Received:2022-09-23 Published:2022-11-05
引用本文:

罗勇, 尤田, 白露, 陈纳纳, 张新涛, 杨清均, 卢文倩, 李佳峒, 黄显程. 合并肱骨小头软骨损伤及骨间背侧神经卡压的顽固性网球肘一例的治疗体会[J]. 中华肩肘外科电子杂志, 2022, 10(04): 358-362.

网球肘,学名肱骨外上髁炎,是一种过度使用损伤,发病机制是伸肌总腱中特别是桡侧腕短伸肌腱(extensor carpi radiadis brevis,ECRB)起点处的过度负荷。主要是由于负重、反复伸腕等活动引起的重复性劳损,常见于网球、羽毛球、壁球等体育运动[1,2,3] 。通常网球肘疼痛不剧烈,采取非手术治疗可以在1~2年内恢复,但也有少数顽固性网球肘迁延不愈,或合并其他疾病导致病情加重,现报道1例严重疼痛的顽固性网球肘病例,该病例合并肱骨小头软骨损伤及骨间背侧神经卡压,经过手术治疗后疼痛缓解。

图1 患者汪某,女,47岁,术前冠状位MRI提示伸肌总腱部分撕裂
图2 患者术前矢状位MRI提示肱骨小头软骨下骨囊肿
图3 患者术前用彩超定位了桡神经的体表走行
图4 患者切开后暴露骨间背侧神经受卡压注:红箭头所示为神经松解后可见变细的神经
图5 患者术前体表标记注:红圈所示为前上外入路
图6 患者经前上外入路建立尺侧前上入路
图7 患者用交换棒向尺侧钝性分离直至皮下注:红圈所示为交换棒的钝头
图8 用交换棒已建立好尺侧前上入路
图9 将刨刀自关节镜鞘管插入关节腔
图10 患者的镜下表现注:红箭头所示为撕裂的肌腱
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