CAJ | 학술논문

目的报告腕关节镜掌侧入路的设计及初步应用结果.方法腕关节镜掌桡侧入路定位在桡侧腕屈肌腱桡侧与舟骨结节交界处,掌尺侧入路定位在尺侧腕屈肌腱的尺侧缘、豌豆骨近侧0.5 cm处.对20具防腐腕关节以上离断标本进行解剖学研究,5具新鲜腕关节以上离断标本进行模拟镜下手术.2004年4月至2008年1月,共进行腕关节镜掌侧入路手术20例.男8例,女12例;年龄21～64岁,平均35.6岁.结果掌侧入路与其周围的血管、神经等结构均有一定的安全距离.掌侧入路镜检可以清晰显示背侧关节囊、舟月骨间韧带的掌侧部分和月三角骨间韧带的掌侧部分.通过掌侧入路置入关节镜,背侧入路置入手术器械,可以更方便地处理腕关节腔背侧部分的病变.20例临床病例均未发生并发症,平均随访23.4(12～37)个月.末次随访时,腕关节背伸-掌屈活动度为134°±16°,桡尺偏活动度为39°±8°,旋前-旋后活动度为139°±18°.术前有2例疼痛为Ⅱ级,18例疼痛为Ⅲ级;末次随访时,11例疼痛为Ⅰ级,8例为Ⅱ级,1例为Ⅲ级;疼痛缓解显著(Z=31.2,P＜0.01).改良Garland和Werley评分为:优10例,良6例,可4例,优良率为80%.结论腕关节镜掌侧入路是传统背侧入路的重要补充,具有安全性高、操作方便的优点.
목적 보고완관절경장측입로적설계급초보응용결과.방법 완관절경장뇨측입로정위재뇨측완굴기건뇨측여주골결절교계처,장척측입로정위재척측완굴기건적척측연、완두골근측0.5 cm처.대20구방부완관절이상리단표본진행해부학연구,5구신선완관절이상리단표본진행모의경하수술.2004년4월지2008년1월,공진행완관절경장측입로수술20례.남8례,녀12례;년령21～64세,평균35.6세.결과 장측입로여기주위적혈관、신경등결구균유일정적안전거리.장측입로경검가이청석현시배측관절낭、주월골간인대적장측부분화월삼각골간인대적장측부분.통과장측입로치입관절경,배측입로치입수술기계,가이경방편지처리완관절강배측부분적병변.20례림상병례균미발생병발증,평균수방23.4(12～37)개월.말차수방시,완관절배신-장굴활동도위134°±16°,뇨척편활동도위39°±8°,선전-선후활동도위139°±18°.술전유2례동통위Ⅱ급,18례동통위Ⅲ급;말차수방시,11례동통위Ⅰ급,8례위Ⅱ급,1례위Ⅲ급;동통완해현저(Z=31.2,P＜0.01).개량Garland화Werley평분위:우10례,량6례,가4례,우량솔위80%.결론 완관절경장측입로시전통배측입로적중요보충,구유안전성고、조작방편적우점.
Objective To report the design and initial results of the volar portals of wrist arthroscopy.Methods The volar radial portal was located at the junction of flexor carpal radialis tendon and scaphoid tuberosity,while the volar ulnar portal was at the ulnar side of flexor carpal ulnaris tendon and0.5 cm proximal to pisiform.Twenty embalmed wrist specimens were used for anatomical measurements,and5 fresh-frozen wrist specimens for trial arthroscopy.From April 2004 to January 2008,20 wrist arthroscopies in which at least one volar portal was used were performed.There were 8 males and 12 females.Their ages ranged from 21-64 years(average,35.6 years).Results There was a safe zone surrounding the portal that was free of any neurovascular structures.The structures that could be clearly visualized included the dorsal capsule,the palmar segment of the scapholunate interosseous ligament and the palmar segment of the lunotri-quetral interesseous ligament.It was easy to address the dorsal wrist lesions when the arthroscopy was placed at the volar portal and the instrument was placed through the dorsal portal.No complication was found in the clinical cases.All cases were followed up for an average of 23.4 months(range,12-37 months).At the last follow-up,the dorsal and plantar flexion motion arc of the wrist reached 134°±16°,the radial and ulnar mo-tion arc 39°±8°,and the pronation and supination motion arc 139°±18°.In terms of the pain scores,there were 2 cases in grade Ⅱ,18 in grade Ⅲ before the surgery,and at the final follow-up,the pain was signifi-cantly alleviated with 11 cases in grade Ⅰ,8 in grade Ⅱ and Ⅰ in grade Ⅲ(P＜0.01).According to Gartland and Werley rating scale,10 cases were rated as excellent,6 as good,4 as fair.The excellent and good rate was 80%.Conclusion The volar approach is safe and feasible procedure and is supplemental to the tradi-tional dorsal portals.