改进的踝关节镜后方共轴入路的解剖学研究及初步临床应用

发布时间：2018-10-18 12:52

【摘要】：目的：评估改进的踝关节后方“共轴入路”的安全性和可操作性。类型：解剖研究和临床应用。方法：20具防腐冷冻踝关节标本平分为两组；用克氏针在其中一组建立文献报道的“共轴入路”、传统后方入路和改进的踝关节后方“共轴入路”；另一组分别在距离外踝尖端近侧1.5cm高度水平2.5cm建立改进的“共轴入路”。测量克氏针与踝关节后室重要解剖结构的距离。使用2.7mm，，30°关节镜在5具新鲜标本上模拟实际手术建立改进的踝关节后方“共轴入路”。临床应用于3例病例(4个踝关节)。结果：改进的“共轴入路”与小隐静脉、足拇长屈肌腱和胫神经的距离分别是22.07mm、5.39mm和6.27mm；原“共轴入路”与小隐静脉、足拇长屈肌腱和胫神经的距离分别是8.54mm、3.62mm和4.40mm。不同高度的“共轴入路”的静态安全性接近。测量数值经统计学分析得出：改进的踝关节后方“共轴入路”同其它后方入路相比，器械距离踝关节后方重要解剖结构是最大的。通过模拟手术过程，确定足拇长屈肌腱和足趾长屈肌腱为踝关节镜操作的安全性“内标志”。无神经血管的穿破和触碰。临床病例平均5个月随访未见并发症。结论：与原“共轴入路”相比，改进后的踝关节后方“共轴入路”具有安全性更高、操作更简单和易重复的优势。
[Abstract]:Objective: to evaluate the safety and maneuverability of the modified posterior ankle coaxial approach. Type: anatomical study and clinical application. Methods: 20 antiseptic frozen ankle joint specimens were divided into two groups: "coaxial approach", traditional posterior approach and modified posterior "coaxial approach" with Kirschner needle. In another group, the improved "coaxial approach" was established at the height of 1.5cm at the proximal lateral malleolus. The distance between Kirschner's needle and the important anatomical structure of the posterior chamber of ankle joint was measured. The modified posterior "coaxial approach" of ankle joint was established by using 2.7 mm 30 掳arthroscope on 5 fresh specimens simulated by actual operation. Clinical application was performed in 3 cases (4 ankle joints). Results: the distance between the improved "coaxial approach" and small saphenous vein, flexor pollicis longus tendon and tibial nerve was 22.07 mm 5.39 mm and 6.27 mm respectively, and the distance between the original "coaxial approach" and small saphenous vein, flexor pollicis longus tendon and tibial nerve was 8.54 mm ~ 3.62 mm and 4.40 mm respectively. The static security of different heights of the "coaxial approach" is close. The results of statistical analysis show that the modified posterior "coaxial approach" is the most important anatomic structure in the posterior of ankle joint compared with other posterior approaches. The flexor pollicis longus tendon and flexor digitorum longus tendon were determined to be the internal marks of ankle arthroscopic operation. No piercing or touching of nerve and blood vessels. The clinical cases were followed up for an average of 5 months without complications. Conclusion: compared with the original "coaxial approach", the improved posterior "coaxial approach" has the advantages of higher safety, simpler operation and easier repetition.
【学位授予单位】：南京中医药大学
【学位级别】：硕士
【学位授予年份】：2005
【分类号】：R322;R687.3

【参考文献】