摘要
目的比较不同体位下各种肘关节镜入路与毗邻神经血管的解剖关系，评价肘关节镜操作中各种标准入路的安全性及应用价值。方法选用新鲜尸体肘关节10个进行解剖，测量9种标准肘关节镜入路与毗邻神经血管的最近距离，并根据各入路下关节镜检的镜下视野及操作灵活性评价其应用价值。结果肘关节镜入路与毗邻神经距离受注水膨胀关节、肘关节伸直或屈曲及前臂旋前或旋后体位变化影响。肘关节屈曲900前臂旋后、中立、旋前位，前外侧入路关节镜套管与桡神经距离分别为（2．9±1.1）mm、（4．5±1．5）mm、（5．8±1．7）mm，穿刺造成神经损伤风险大；肘关节伸直前臂旋后位2例肘关节中套管与桡神经直接接触。近端前内侧或近端前外侧入路观察肘关节前间室、后正中入路观察后间室视野良好且穿刺风险小。后方入路均安全。结论近端前内侧或近端前外侧入路优于前内侧或前外侧入路，与后正中入路结合应用可基本满足多数肘关节镜手术的要求，是一组安全、有效的入路点。
Objective To evaluate the safety and value of standard portals used in elbow arthroscopy by comparing the anatomic relationships between the arthroscopic portals and nearby neurovascular structures at different positions. Methods The dissections were performed in 10 fresh cadaveric elbows. The minimum distances from the 9 standard paths of the arthroscopie sheath to nearby neurovascular structures were then measured and the value of each portal was assessed in terms of its effects on the elbow arthroscopy. Results The approach-to-nerve distance was affected by joint distention with fluid, elbow extension/flexion and forearm supination/pronation. The radial nerve showed significant proximity to the anterolateral portal in full elbow extension and forearm supination, the minimum distance from the anterolateral portal to radial nerve was （2.9 ± 1.1） mm, （4.5 ± 1.5） mm, （5.8 ± 1.7） mm respectively when the elbow was in 90° of flexion with the forearm supinated midpronation and pronation, and nerve-pin contact was observed in 2 elbows in the extended positions. The proximal medial portal and the proximal lateral portal for the anterior compartment, and the posterocentral portal for the posterior compartment, were shown to have an optimum effect with the least complications. All of the posterior approaches were safe. Condusions The proximal approaches are safer than the anteromedial and anterolateral approaches. The proximal medial portal, proximal lateral portal and posterocentral portal should be used as standard portals in elbow arthroscopy.
出处
《中华创伤骨科杂志》
CAS
CSCD
2008年第12期1141-1144,共4页
Chinese Journal of Orthopaedic Trauma
关键词
肘关节
关节镜
入路
解剖
Elbow
Arthroscopy
Anatomy
Approach
