Elbow synovectomy via lateral approach

Elbow synovectomy combined with humeral head resection is currently the best surgical method for the treatment of elbow joint rheumatoid arthritis. Contrary to the knee, hip, wrist and hand synovectomy, the range of joint motion after the elbow synovectomy is not reduced, and can be improved to varying degrees, especially the improvement of the forearm rotation function. An enlarged outer approach is generally employed. However, if accompanied by ulnar nerve symptoms, an auxiliary incision can be made on the medial side, followed by ulnar nerve advancement. If accompanied by distal synovial joint synovitis, simultaneous ulnar resection can be performed. Treating diseases: surgical steps Incision A straight incision approach to the outside of the elbow or a lateral J-shaped incision approach to Kocher may be used. From the upper part of the incision, about 4 horizontal fingers above the upper iliac crest, along the upper iliac crest, to the lower edge of the humerus, and then to the lower back, stop at the posterior side of the upper ulna, the incision is long. 10 to 12 cm. 2. Exposing the joint capsule Cut the shallow, deep fascia along the direction of the incision. The lateral muscle space is found in the upper part of the incision and enters along the muscle interval to reach the lateral epicondyle of the humerus. Above the tip of the incision, the phrenic nerve is separated from the posterior aspect of the humerus through the lateral muscles into the space between the diaphragm and the diaphragm, and damage should be avoided. Using the scalpel and periosteal stripper, the diaphragm, the extensor digitorum and the extensor muscles of the ankle are exfoliated from the lateral epicondyle and the upper epiphysis, respectively, and are pulled forward, and the elbow muscle is self-sacral and external. Peel off and pull back. In the lower part of the incision, the gap between the ulnar wrist extensor muscle and the elbow muscle is deep, and is pulled to both sides to expose the upper part of the supinator muscle. The muscle was exfoliated from the external iliac crest, the iliac collateral ligament, the annular ligament and the ulna, and pulled forward to fully expose the lateral side of the elbow joint and the dorsal side of the upper ulnar joint. The anterior branch of the iliac crest bone that passes through the supinator muscle should be avoided when the origin of the supinator muscle is removed. Use the periosteal stripper to peel forward along the lateral joint capsule, separate the important soft tissue in front of the elbow joint from the anterior joint capsule, and pull it forward with a hook. The posterior soft tissue and the posterior joint capsule are separated and pulled back. The front, outer and rear of the elbow joint can be more fully revealed. 3. Exposure of the slip film The anterior and posterior joint capsules were cut transversely, and the annular ligament was obliquely cut. The lateral joint capsule was cut open, and the edema and hypertrophic synovial tissue bulged, but attention should be paid to retain the lateral joint capsule and ligament as much as possible. 4. Excision of the humeral head and synovium In adults, in order to facilitate the removal of the synovial membrane, the humeral head should be removed first. The synovial tissue of the ankle joint and the upper ulnar joint was excised with a knife and a scissors, and then the synovial tissue in front of and behind the ulnar joint was excised. In order to reveal and remove the synovial tissue inside the ulnar joint, the affected limb can be inverted as much as possible to increase the lateral joint space. Care should be taken to remove the synovial membrane at the ulnar intercondylar sulcus and the synovial membrane at the ulnar notch, which will help to improve flexion contracture of the elbow joint. After the synovial resection, the granulation tissue at the lower end of the humerus and the cartilage surface of the olecranon is scraped with a small curette. Special attention should be paid to scraping the granulation tissue in the olecranon and the coronal fossa. Scrape. 5. Suture incision Relax the tourniquet, flush the incision with isotonic saline, and place 0.5 to 1.0 ml of methyl acetate. The annular ligament, joint capsule, and exfoliated tendon were then sutured, and the incision was sutured layer by layer. The elbow joint was flexed to 90°, wrapped with a thick cotton pad and elastic bandage, and suspended with a bandage.

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