What is a Brachioplasty?

Moving elbow joints are very important for people's life and work, especially joint movements between 90 ° and 180 °. People with limited elbow movement and severe pain, or ankylosis in non-functional positions need to relieve pain and restore function. The function of the elbow joint is movement plus a certain degree of stability. Elbow joint resection is difficult to maintain stability, there are many complications of elbow joint prosthetic replacement, and fascioplasty is still a feasible treatment with a curative effect of 78%.

Elbow arthroplasty

Moving elbow joints are very important for people's life and work, especially joint movements between 90 ° and 180 °. People with limited elbow movement and severe pain, or ankylosis in non-functional positions need to relieve pain and restore function. The function of the elbow joint is movement plus a certain degree of stability. Elbow joint resection is difficult to maintain stability, there are many complications of elbow joint prosthetic replacement, and fascioplasty is still a feasible treatment with a curative effect of 78%.

Chinese name

Elbow arthroplasty

Foreign name

Elbow arthroplasty

Moving elbow joints are very important for people's life and work, especially joint movements between 90 ° and 180 °. People with limited elbow movement and severe pain, or ankylosis in non-functional positions need to relieve pain and restore function. The function of the elbow joint is movement plus a certain degree of stability. Elbow joint resection is difficult to maintain stability, there are many complications of elbow joint prosthetic replacement, and fascioplasty is still a feasible treatment with a curative effect of 78%.

1. The shoulder joint function of the affected limb should be normal. If the muscles controlling the joints such as the biceps and forearm muscles are atrophic, exercise and various physical therapies should be performed first. Perform this operation after the muscles recover or improve .

2. If there is a large scar on the elbow, scar scar removal and free skin grafting can be performed first. Arthroplasty is performed 4 to 6 weeks after successful skin grafting.

3. Antibiotics should be given to patients who have secondary infection due to septic arthritis or tuberculosis.

4. In addition to skin preparation for the affected limb, one thigh skin should be prepared for broad fascia.

Gluteal plexus anesthesia or general anesthesia.

1. Posture position, the affected limb is placed on a small surgical table or supine position, the affected limb is placed on the chest.

2. Incision, separation of the ulnar nerve, and exposure of the elbow joint see "exposure to the posterior side of the elbow joint". Subperiosteal exposure of the lower third of the humerus, ulna olecranon and radial head.

3. Cut the switch section and trim the bone end with a bone knife to gradually open the fusion of the humerus, humerus and ulna proximal joints along the joint space, and peel the anterior humerus under the periosteum. Then, flex the elbow joint so that the lower end of the humerus and the upper end of the ulnar radius protrude under the incision. The lower end of the humerus was cut by 1 ~ 1.5cm with a bone knife, and it was repaired into a convex arc shape from front to back. Use a curved chisel to remove the superficial bone of the ulnar half-moon notch to deepen and lengthen it, and then remove the radial head and neck. The plane of the lower edge of the ulnar notch should be used to file away all the bone-cutting surfaces. If there is a bony connection between the upper ulnar radial joint, it should also be completely removed and sutured with surrounding soft tissue to allow the forearm to fully rotate. At this time, the distance between the two bone ends of the elbow joint is about 1.5 to 2.0 cm. Use a fine drill at the epicondyle on both sides of the lower end of the humerus to drill a bone hole from back to front for suture and fixation of the fascia, remove all ossified tissue and scars in the soft tissue, and remove all bone fragments . After rinsing to completely stop bleeding, temporarily fill the incision with hot saline gauze to prevent bleeding.

4. Cut the wide fascia and make a straight incision in the middle of the outer thigh of the disinfected drape to expose the wide fascia. Remove the 8cm long and 5cm wide wide fascia for later use. Suture the incision.

5. Wrap the end of the bone, fold the smooth side of the fascia inward, and the rough side outward (to cover the end of the bone), and sew the middle part with the corresponding part of the anterior joint capsule with three chrome bowel or silk threads. The upper half of the fascia is used to wrap the lower humerus cut surface, and the fascia is sutured by threading through the drilled hole on the lower end of the humerus. Adjacent part of the cut surface. If the width of the fascia is not enough, another small piece of fascia can be used, suture with a purse, and wrap the radial head alone.

6. Suture reset and maintain the joint in the 90 ° flexion position, suture layer by layer from the distal end to the proximal end. If the triceps aponeurotic flap is cut, a Y-shaped suture should be used to extend it, and free movement of the elbow is guaranteed. After bandaging at the end of the operation, the elbow joint was fixed at the functional position with anterior and posterior plaster support.

1. Note that the range of resection of the lower end of the humerus and the upper end of the ulna should be appropriate, not too much or too little. Too much will cause forearm muscles to lose attachment, affect elbow extension and flexion strength, and weaken joint stability. Too little resection will affect the movement of the joint after surgery.

2. Before placing the fascia sheet, the hemostasis of the bone end should be thorough, so as to avoid the formation of hematoma between the fascia sheet and the bone end, which will not only affect the healing of the fascia and the bone end, but also be prone to infection, mechanization or ossification of the hematoma. Will affect the effect.

1. Raise the affected limb after surgery to facilitate circulation and reduce swelling. Encourage patients to do the activities of the affected side's fingers, wrists and fists as soon as possible.

2. The suture is removed 2 weeks after surgery, and the plaster support can be removed regularly after 3 weeks (3 times a day, 1 to 2 hours each time), and the flexion and extension of the elbow joint and the rotation of the forearm are gradually started, and physical therapy and sleep are performed. When it is still fixed with a plaster support, if the activity is good and the muscle strength is strong after 8 weeks, you can remove the plaster. During exercise, do not forcefully and passively move the joints to prevent the soft tissue around the joints from bleeding, mechanization, and adhesions, which will affect the recovery of joint function. Actively exercise the upper extremity muscles for at least 6 months, and generally take about 2 years to obtain the maximum muscle strength. .