1、皮肤切口
Skin incision
Start the incision 2 cm proximal to the lateral humeral epicondyle.
Carry the incision across the elbow joint, over the radial head, and approx. 5 cm distal to the joint.
在肱骨外髁上2cm处向下延伸，越过肘关节，至桡骨头上方，至关节前方5cm处。 注意 Note
The posterior interosseous nerve, within the supinator muscle, crosses the posterior radius, from anteriorly, three finger-breadths distal to the radial head. It must be protected during this approach.
骨间背神经位于旋后肌内，在距离桡骨头3个手指宽度处，从桡骨前外侧面穿至背面，此入路必须注意保护。
2、浅层分离 Superficial surgical dissection
Incise the subcutaneous tissue and deep fascia in line with the incision.
Elevate anterolaterally the subcutaneous tissue and find the interval between the anterior border of the anconeus and the extensor carpi ulnaris muscle.
There may be difficulties in determining the interval between these two muscles because of bruising and bleeding in trauma.
与切口一致，向下切口深筋膜和深筋膜。将皮肤及皮下组织向两侧牵开，找到肘肌及尺侧腕伸肌直接间隙，实际操作中因为挫伤或创伤出血可能比较困难。
3、深层手术分离 Deep surgical dissection
Separate anconeus from extensor carpi ulnaris. Elevate them from the joint capsule.
Incise the joint capsule to expose the radial head and the annular ligament. Note
The annular ligament is entered 1 cm anterior to the ulna to prevent injury to the lateral ulnar collateral ligament.
分离肘肌及尺侧腕伸肌，牵开，切开关节囊，显露桡骨头和侧副韧带。 注意：侧副韧带应在尺骨外侧1cm处切开，避免损伤尺骨侧副韧带。
4、肱骨外髁截骨（非必须）
Osteotomy of lateral epicondyle
A variation for lateral exposure with preservation of collateral ligaments and
extensor tendon origin involves osteotomy of the lateral humeral epicondyle. The osteotomy line in the illustration is marked in red.
截骨线如下图示
The soft tissues and epicondyle are reflected anteriorly to provide access to the proximal radius and ulna.
Repair after this approach requires fixation of the epicondyle. The necessary screw hole can be drilled before the osteotomy.
术后必须固定肱骨外髁
5、避免损伤桡神经 Avoiding damage to radial nerve
∙
∙
∙ Fully pronating the forearm protects the posterior interosseous nerve by moving it away from the operative field. Beware of incising the capsule too far anteriorly as the radial nerve lies over the front of the anterolateral portion of the elbow capsule. Beware of dissection distal to the annular ligament or strenuous retraction, because the posterior interosseous nerve lying within the supinator muscle is at risk.
1.完全旋后前臂可以使骨间背神经离开切开区域
2.注意由于桡神经在肘部位于前外侧，避免切开关节囊太靠前。
3.在切口远端避免过度牵拉，以免损伤位于旋后肌内的骨间背神经。
1、皮肤切口
Skin incision
Start the incision 2 cm proximal to the lateral humeral epicondyle.
Carry the incision across the elbow joint, over the radial head, and approx. 5 cm distal to the joint.
在肱骨外髁上2cm处向下延伸，越过肘关节，至桡骨头上方，至关节前方5cm处。 注意 Note
The posterior interosseous nerve, within the supinator muscle, crosses the posterior radius, from anteriorly, three finger-breadths distal to the radial head. It must be protected during this approach.
骨间背神经位于旋后肌内，在距离桡骨头3个手指宽度处，从桡骨前外侧面穿至背面，此入路必须注意保护。
2、浅层分离 Superficial surgical dissection
Incise the subcutaneous tissue and deep fascia in line with the incision.
Elevate anterolaterally the subcutaneous tissue and find the interval between the anterior border of the anconeus and the extensor carpi ulnaris muscle.
There may be difficulties in determining the interval between these two muscles because of bruising and bleeding in trauma.
与切口一致，向下切口深筋膜和深筋膜。将皮肤及皮下组织向两侧牵开，找到肘肌及尺侧腕伸肌直接间隙，实际操作中因为挫伤或创伤出血可能比较困难。
3、深层手术分离 Deep surgical dissection
Separate anconeus from extensor carpi ulnaris. Elevate them from the joint capsule.
Incise the joint capsule to expose the radial head and the annular ligament. Note
The annular ligament is entered 1 cm anterior to the ulna to prevent injury to the lateral ulnar collateral ligament.
分离肘肌及尺侧腕伸肌，牵开，切开关节囊，显露桡骨头和侧副韧带。 注意：侧副韧带应在尺骨外侧1cm处切开，避免损伤尺骨侧副韧带。
4、肱骨外髁截骨（非必须）
Osteotomy of lateral epicondyle
A variation for lateral exposure with preservation of collateral ligaments and
extensor tendon origin involves osteotomy of the lateral humeral epicondyle. The osteotomy line in the illustration is marked in red.
截骨线如下图示
The soft tissues and epicondyle are reflected anteriorly to provide access to the proximal radius and ulna.
Repair after this approach requires fixation of the epicondyle. The necessary screw hole can be drilled before the osteotomy.
术后必须固定肱骨外髁
5、避免损伤桡神经 Avoiding damage to radial nerve
∙
∙
∙ Fully pronating the forearm protects the posterior interosseous nerve by moving it away from the operative field. Beware of incising the capsule too far anteriorly as the radial nerve lies over the front of the anterolateral portion of the elbow capsule. Beware of dissection distal to the annular ligament or strenuous retraction, because the posterior interosseous nerve lying within the supinator muscle is at risk.
1.完全旋后前臂可以使骨间背神经离开切开区域
2.注意由于桡神经在肘部位于前外侧，避免切开关节囊太靠前。
3.在切口远端避免过度牵拉，以免损伤位于旋后肌内的骨间背神经。