Fasciotomy and surgical tenotomy for recalcitrant lateral elbow tendinopathy: early clinical experience with a novel device for minimally invasive percutaneous microresection.
筋膜切开术和外科肌腱切开术治疗顽固性肘关节外侧腱病: 使用一种新型微创经皮显微切除术装置的早期临床经验。

摘要

BACKGROUND:The optimal choice for intervention for recalcitrant lateral elbow tendinopathy remains unclear as various treatment modalities have documented comparable results in the literature.
PURPOSE:To explore the safety, tolerability, and early efficacy of a new minimally invasive mode of treatment that delivers focused, calibrated ultrasonic energy, effectively microresecting the pathological tendon and removing only pathological tissue.
STUDY DESIGN:Case series; Level of evidence, 4.
METHODS:Seven male and 13 female patients aged 33 to 65 years averaging 12.5 months (range, 4-48) of failed nonoperative therapy underwent the ultrasonic microresection procedure in an outpatient clinic setting. The procedure involved a sterile, ultrasound-guided percutaneous microresection with a proprietary device (TX1) performed through a stab incision under local anesthesia. The duration of the procedure and complications of the device or procedure were assessed. Outcome parameters included patient satisfaction; visual analog scale (VAS) pain scores; Disabilities of the Arm, Shoulder and Hand (DASH) scores at 1, 3, 6, and 12 months; and ultrasound assessment at 3 and 6 months.
RESULTS:The median duration for the sterile confirmatory ultrasound examination (phase 1) was 88.5 seconds (range, 39-211; SD, ±47.6), the median duration of the procedure proper (phase 2) was 10.1 minutes (range, 4.1-19.4; SD, ±3.7), and the median energy time (duration the TX1 device was activated) was 32.5 seconds (range, 18-58; SD, ±11.0). No complications were encountered. A significant improvement in VAS score (from 5.5 to 3.3; P < .001) occurred by 1 week, and significant improvements in both DASH-Compulsory (from 21.7 to 11.3; P = .001) and DASH-Work (from 25.0 to 6.3; P = .012) scores occurred by 1 month. The VAS scores further improved at 3, 6, and 12 months (from 2.0 to 1.0 to 0.50; P = .003 and .023). The DASH-Compulsory score improved significantly from 3 to 6 months (from 8.6 to 4.6; P = .003), and both the DASH-Compulsory and DASH-Work scores were sustained by 12 months. Sonographically reduced tendon thickness (19 patients), resolved or reduced hypervascularity (17 patients), and reduced hypoechoic area (18 patients) occurred by 6 months. Nineteen of the 20 patients (95%) expressed satisfaction with the procedure, with 9 patients being very satisfied with their overall experience at 6 months after the procedure, 10 patients somewhat satisfied, and 1 patient neutral.
CONCLUSION:Ultrasonic microresection of diseased tissue with the TX1 device provides a focally directed, safe, specific, minimally invasive, and well-tolerated treatment for recalcitrant lateral elbow tendinopathy in an office-based or ambulatory surgical setting with good evidence of some level of efficacy in 19 of 20 patients (95%) that is sustained for at least 1 year.

译文

背景: 对于顽固性肘关节外侧腱病的最佳干预选择仍不清楚,因为各种治疗方式在文献中记录了类似的结果。
目的: 探索一种新的微创治疗模式的安全性、耐受性和早期疗效,这种治疗模式提供集中、校准的超声能量,有效地对病理性肌腱进行显微切割,只去除病理性组织。
研究设计: 案例系列; 证据水平,4。
方法: 7 名男性和 13 名女性患者,年龄 33 至 65 岁,平均 12.5 个月 (范围,4-48) 的非手术治疗失败,他们在门诊接受了超声显微检查。该过程包括在局部麻醉下通过刺破切口进行无菌、超声引导下的专有装置 (TX1) 的经皮显微切除术。评估手术的持续时间和装置或手术的并发症。结果参数包括患者满意度; 视觉模拟量表 (VAS) 疼痛评分; 1 个月、 3 个月、 6 个月和 12 个月时手臂、肩膀和手的残疾 (DASH) 评分; 和 3 个月和 6 个月的超声评估。
结果: 无菌确认性超声检查 (第一阶段) 的中位持续时间为 88.5 秒 (范围,39-211; 标准偏差,± 47。 6),手术本身 (第二阶段) 的中位持续时间为 10.1 分钟 (范围,4.1-19.4; 标准偏差,± 3。 7),和中位能量时间(TX1 设备被激活的持续时间) 为 32.5 秒 (范围,18-58; SD,± 11.0)。未遇到并发症。VAS 评分显著提高 (从 5.5 到 3.3; P <。 001) 发生了 1 周,并且在两个破折号强制性显著改善 (从 21.7 到 11.3; P =。 001) 和破折号工作 (从 25.0 到 6.3; P =。 012) 得分发生在 1 个月。在 3 、 6 和 12 个月时,VAS 评分进一步提高 (从 2.0 到 1.0 到 0.50; P =.003 和.023)。破折号强制评分从 3 个月显著提高到 6 个月 (从 8.6 提高到 4.6; P =。 003),并且 DASH-必修和 DASH-工作分数都持续了 12 个月。6 个月前出现超声肌腱厚度减少 (19 例患者) 、血管增生消退或减少 (17 例患者) 和低回声面积减少 (18 例患者)。20 名患者中有 19 名 (95%) 表示对手术满意,其中 9 名患者对手术后 6 个月的总体体验非常满意,10 名患者有些满意, 和 1 名患者中立。
结论: 用 TX1 装置对病变组织进行超声显微检查提供了一个聚焦的、安全的、特异性的、微创的, 在办公室或门诊手术环境中,对于顽固性肘关节外侧腱病的耐受性良好的治疗,在 20 名患者中的 19 名 (95%) 中有良好的疗效证据这将持续至少一年。

fasciotomy

骨科 筋膜间室综合征 治疗方法
概述  :  

筋膜间室综合征的治疗原则是早期诊断、彻底减压,目前小腿筋膜切开术主要包括双切口筋膜切开术和外侧单切口筋膜切开术。 术式沿革小腿筋膜间室的手术减压方式经历了由双切口到外侧单切口再到双切口的过程,双切口最初主要用于治疗战争中受伤的士兵,可以对小腿4个筋膜间室充分减压;外侧单切口主要通过切除腓骨进行减压,可以对小腿后深筋膜间室彻底减压;双切口再次被临床采用,是因为外侧单切口需要切除腓骨进行减压,容易增加手术并发症。2008年Maheshwari等报道的前外侧单切口筋膜切开术,是由小腿前外

Fasciotomy  /fæʃi'ɔtəmi/    

释义   n. [外科] 筋膜切开术

例句   Fasciotomy is necessary and useful to prevent the ischemic contracture. 深筋膜切开术是预防缺血性肌挛缩的重要辅助措施。


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