肘关节外侧入路.doc

肘关节外侧入路
2011-11-2315:52:02|分类：HYPERLINK"http://feiying9005.blog.163.com/blog/"\l"m=0&t=1&c=fks_084064092094084074086086081095093080089065087087085070"\o"手术入路"手术入路|标签：|举报|字号大中小订阅
Skinincision
Theincisionstartsoverthelateralsupracondylarridge,5cmproximaltotheelbowjoint.Itpassesdistallytothelateralsurfaceoftheproximalforearm,posteriortotheradialhead.NoteBecarefuloftheradialnerve,whichrunsclosetotheradialheadandneck.Itdividesintoitssuperficialanddeepbranchesattheleveloftheradialhead.

Deepdissection
Thedeepfasciaisincisedinlinewiththeskinincision.

Thelateralhumeralepicondyleisexposedbydevelopingtheintervalbetweenthetricepsmuscleposteriorly,andthebrachioradialisandextensorcarpiradialislongusanteriorly.Thedissectioniscontinueddistallybetweentheextensorcarpiulnarisandtheanconeusmuscles.Theredlinemarksthesiteofthecapsulotomy,whichisshowninthenextstep.

Openingthejoint
Thejointcapsuleisincisedlongitudinallyfromthedistalpartofthelateralhumeralepicondyle,overthecapitellumandthenoverthepostero-lateralaspectoftheradialhead.Alternatively,thecapsulecanbeincisedasaproximallybasedU-shapedflap.

Theexposureofthecapitellumandtheradialheadisseeninthisphotograph.
Furtherexposure
Subperiostealreflectionofthebrachioradialisandextensorcarpiradialislongusanteriorly,andthetricepsposteriorlywillimprovejointexposure.
NoteBecarefulwhenplacingtheanteriorretractorastheradialnerveisatrisk.