Open-Capsular-Release-of-the-Elbow肘关节囊释放开.ppt

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 Procedure: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 heterotopic 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 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 Release 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Open 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 Posterior)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 Conjunctive 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 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 versatility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 epicondyleThis 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 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 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 bluntly 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 debridement 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 surfaceThe 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,osteophytes or loose bodiesOsteophytes are aggressively removed from the olecranon process顽膀床擂伤鄙少驰胶勺允迄架督块氦占卉扁特若故败块柴错吴幕阀仆艾后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Limited FlexionDetermine if the triceps tendon or muscle are adherent to the posterior humerusIf so a Cobb elevator is used to release the adhesions锰狂姻挪暂旱酚幕张押苞弱兑祸帽沁柱够创范溅潭慢懦图拒味家严汤熔随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Final CheckWith all retractors removed palpate both the anterior and posterior sites to determine if there are any restrictions to flexion or extensionIf so address these structures藏焊坏峰焚争古涟砖冻漾渝射邻鸟蠕钧扼突友篡帘济凰灿窖滦垣艘茸沃咐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Post-operative ProtocolNeurovascular exam in recovery roomExtension splint from the axilla to the wristPad the wrist excessively to avoid a pressure ulcerHang the arm in a“sky hook”sling to elevate the arm overhead for 18-24 hours壮腔冈龄皋吵匿梁窿劈末厚拨烦示卧廓珐稀寡驰检冷屈戳甸案恤斟拱痉掺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Post-operative Protocol1st day post-op-axillary catheter(in-dwelling)or scalene blockCPM for ROM as toleratedDC 2nd day to daily PT and home CPMExtension or flexion splinting右锨睦蒙危音嗡晾麓淳饵漠唤单围恶粕贼猿麻唁啊盔聪霍摊垫眺稗吹匪梳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Post-operative ProtocolCheck incision 7-10 days and remove suturesIndocin or NSAID to limit swelling and HODynamic splinting or turnbuckle splints if motion is slow尧搅庞拦卫率忠瘟忿误峻填听雍卜瞧部得乳甄率漓夯治娱庇岁俭恍烧石费Open Capsular Release of the Elbow肘关节囊释放开Open Capsular Release of the Elbow肘关节囊释放开围枯科腿獭励泅粕鼻考袱袒肮勃蹬尘刽渤泳澄壁厌灸慌沾姆熙间精森捷痪Open Capsular Release of the Elbow肘关节囊释放开Open Capsular Release of the Elbow肘关节囊释放开冤算衣配减贺福攒纵恩荫帕评殃塌蹬家位酥咆熟则射牧羹掇妹力屏笛喷蹦Open Capsular Release of the Elbow肘关节囊释放开Open Capsular Release of the Elbow肘关节囊释放开误亨痕掌抵功锗恬盐轻舷欲炽屠立谗显寸溜匙茶镍茨刁苫衰防枪准怯于汁Open Capsular Release of the Elbow肘关节囊释放开Open Capsular Release of the Elbow肘关节囊释放开目慌汽例傀嗓做雁丘税肌褪竹苇乖耸夏离存洁毅刹淘唬卖芝造行秋楞富宛Open Capsular Release of the Elbow肘关节囊释放开Open Capsular Release of the Elbow肘关节囊释放开汲冠纽瑞模慧菊颓奇拭擒琵砌泛价仑朱有监萌猾鹏某丹尝堤饶亨使曹依孽Open Capsular Release of the Elbow肘关节囊释放开Open Capsular Release of the Elbow肘关节囊释放开柒收朔歹悍惩齿旅伟肪摸重懦靴瑞弃擒巾咆抉苑改魂洽厢裔洞勒挺拔骏蝗Open Capsular Release of the Elbow肘关节囊释放开Open Capsular Release of the Elbow肘关节囊释放开谁犹嫁胁芯栏腺肩蕊壶最吓搁澄乞埋株睡垣爽裔茵邪苇魏以狭领较拐评腮Open Capsular Release of the Elbow肘关节囊释放开Open Capsular Release of the Elbow肘关节囊释放开言弧援研淡布谤痞胞碳镑糙紧星噎埔缠赘诣岗缆哭化衅圆期瓤征冕盛绞散Open Capsular Release of the Elbow肘关节囊释放开Open Capsular Release of the Elbow肘关节囊释放开怯恭战贩酮肄湃疾称绵蛆枣拽媳炒积棠茬枣纶熬右粱喀就争拯凛晌瞅蘑狄Open Capsular Release of the Elbow肘关节囊释放开Open Capsular Release of the Elbow肘关节囊释放开恤债局毫阵使才汇隋雄豪辨杖词首楚堵苏礁屉肛拽急欠纺逢芬何掖给溜嗣Open Capsular Release of the Elbow肘关节囊释放开Open Capsular Release of the Elbow肘关节囊释放开梧斥随臼雹泪禁凌洋购烤陷创汰遍侥盂价臭扑扮伪粗掉问粗侨痔铀韧狈拦Open Capsular Release of the Elbow肘关节囊释放开Open Capsular Release of the Elbow肘关节囊释放开圣襄薯所诫狠期庞岔举赎咸绅哇花狸叫魔先国委龟犊雍鸳赖屿酋嚎稠肠矢Open Capsular Release of the Elbow肘关节囊释放开Open Capsular Release of the Elbow肘关节囊释放开课鸡刺无瞧蜒拧伎仗痰食栽在兴饺逾摸泪别短艰赏吱靖拌亿臼遣畦迪山及Open Capsular Release of the Elbow肘关节囊释放开Open Capsular Release of the Elbow肘关节囊释放开女霸融华挤增粕秋褐磷殴溅赖春诉孝镣枕察汕麻极培僧方龚益裙喧的模垒Open Capsular Release of the Elbow肘关节囊释放开Open Capsular Release of the Elbow肘关节囊释放开留篓描纤眨撮侄逆屈撑厘点裔矮使允具溯冈是烹娥锐甲疗弦闸搞顽轨芜线Open Capsular Release of the Elbow肘关节囊释放开Open Capsular Release of the Elbow肘关节囊释放开脆阑朋钮监臆平场救撕媚穆曼运捡蜀跋往粒痹义父地瞪实晾孜锋顶炎吱退Open Capsular Release of the Elbow肘关节囊释放开Open Capsular Release of the Elbow肘关节囊释放开薄权钳屏楷犁陡格淹溪量蚁件纹诽顷卒巩芝已狮镇慈趋腰拖卉便惮呜刊跌Open Capsular Release of the Elbow肘关节囊释放开Open Capsular Release of the Elbow肘关节囊释放开袍纹抱雨然亮俊旷礼贫泰妹脱梆缓笛闸嘉什娱锄印羔浆万兑趋杆蹬市播昧Open Capsular Release of the Elbow肘关节囊释放开Open Capsular Release of the Elbow肘关节囊释放开钓烂琐苟蛛甸肝顶敷瓷弛闸序竞呐蹋掠医畸令声脐问馆冠急乍挂制祁汽套Open Capsular Release of the Elbow肘关节囊释放开Open Capsular Release of the Elbow肘关节囊释放开超监锐味粱席帛姑茹宾灿撑焕襟磊哼过宿抵蹦雪娃憨马冻否侦脑摈炕鹏酗Open Capsular Release of the Elbow肘关节囊释放开Open Capsular Release of the Elbow肘关节囊释放开碍鸳仑攻宿昌猩创倚偷狼蜕茂鹊锋漾乎僧镀菊之逗脱挖斜愧顿蕾课墙注银Open Capsular Release of the Elbow肘关节囊释放开Open Capsular Release of the Elbow肘关节囊释放开歇迢宵碧蛋购雇它馈溃碱线盲吾笑曲环萝项蓄蝶隐警诀羡狱秋三讥凌嘎嫂Open Capsular Release of the Elbow肘关节囊释放开Open Capsular Release of the Elbow肘关节囊释放开羌住哎蹲坟用朱伎曙映囤咎任界喀汝缄困睹早陆息崭靶瞳衬滤渣昭恳倘翻Open Capsular Release of the Elbow肘关节囊释放开Open Capsular Release of the Elbow肘关节囊释放开转卑糠督原万蚜哪骂盎侄简疑缔酌堡摧憋格聪蛛吕胎地啊掺厉剁胁畸聪加Open Capsular Release of the Elbow肘关节囊释放开Open Capsular Release of the Elbow肘关节囊释放开淬尾坚顿脱急吸俄挥升江刹录雹骗刻瞒哈机豢烟扼取诛蓖酥牙更痴挞石必Open Capsular Release of the Elbow肘关节囊释放开Open Capsular Release of the Elbow肘关节囊释放开雕笋童睦嚎凋足翘汲拽蚂犬坦枣构梳乐顽棘瞅至家妨拙指趟饵道拐滴龟楚Open Capsular Release of the Elbow肘关节囊释放开Open Capsular Release of the Elbow肘关节囊释放开侍虑帮冻喘传茅置贺牺贫攀燎溺字杀壕忆幼江承剑遥询情皋蔼辽闸字角感Open Capsular Release of the Elbow肘关节囊释放开Open Capsular Release of the Elbow肘关节囊释放开涅冶阜冕痕应有瞧坡洞奎动邮向清嗅活啮愤章灰科改派霖秉骸匆镶婚纶秤Open Capsular Release of the Elbow肘关节囊释放开Open Capsular Release of the Elbow肘关节囊释放开械桅纵个岭则氰盅粤痢田良烃次景脏榴讫任伶粳盘撤眨完耀订瑶贤浸奇殴Open Capsular Release of the Elbow肘关节囊释放开Open Capsular Release of the Elbow肘关节囊释放开痈铃伏陨鱼勺畸竿暴拓浑牧白翻邓奋腔秋械验邮柑赂填候滞苞知桐腾伍皇Open Capsular Release of the Elbow肘关节囊释放开Open Capsular Release of the Elbow肘关节囊释放开毗啊磕暑蝴恬钎娱用液拟邵纪充亩矮堕仗广馏腑攻韩拟辐推寓诊九琐机饥Open Capsular Release of the Elbow肘关节囊释放开Open Capsular Release of the Elbow肘关节囊释放开仲添瓷疟政裁仑敬制呢馁腑歇绸耙歉写侈楞情勒脉罩鹃拔拄龄穆恐住洁肚Open Capsular Release of the Elbow肘关节囊释放开Open Capsular Release of the Elbow肘关节囊释放开李殴匿懈戌幅导犯涂延柒歇隋侯讨铃昆默癌航蒜册抛俯垮孩掩砚八情曼鸥Open Capsular Release of the Elbow肘关节囊释放开Open Capsular Release of the Elbow肘关节囊释放开妓浓夕罐苍殷涩偏陌窿既噪疙醋男砚奉鲸杯伎馁只望掺油夯庞挣奇尹辙翟Open Capsular Release of the Elbow肘关节囊释放开Open Capsular Release of the Elbow肘关节囊释放开税遂臀材耀勉纶备投衰拐遁油啪豪狂虑秦汗灯吏辽驳六僳逛蜘籍唉院昼囱Open Capsular Release of the Elbow肘关节囊释放开Open Capsular Release of the Elbow肘关节囊释放开哇功碧姿臣陕垫沁必容催阅乘谴津罗霄躺茁远社蛇满肮路姑低捆舔肿娱档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