肘关节镜入路的应用研究

发布时间：2018-03-27 14:06

  本文选题：关节镜　切入点：屈曲　出处：《西南医科大学》2017年硕士论文

【摘要】：目的:通过30°和70°关节镜对不同肘关节镜入路的镜下解剖视野进行分析,选择有效(视野佳、入镜容易、镜子操作灵活)的肘关节屈曲最适角度,为肘关节镜手术在临床上的应用提供实验解剖基础。方法:(1)将冰冻的肘关节标本解冻;(2)标记及固定体位:仔细触摸体表的骨性解剖标志,并标记上臂和前臂的内外侧轴线、尺骨鹰嘴、肱骨内上髁、肱骨外上髁等的位置,采用俯卧位方式将解冻的肘关节标本固定在外支架上;(3)建立入路点:通过游标卡尺准确测量且标记肘关节镜所需测量的入路点;(4)建立通道:选用中外侧入路注入20ml水膨胀肘关节腔。首先在近端前内侧入路点作一个仅切开到皮下约3~4mm的切口,然后用直型止血钳分离皮下软组织,再用腰穿针向肘关节中心穿刺,有水流出后拔出腰穿针换用穿刺锥穿刺到肘关节中心,最后用带有镜鞘的穿刺锥穿入肘关节腔并留在关节腔中,保持镜鞘稳定后拔出穿刺锥,有水流出后分别插入4.0mm的30°和70°关节镜;整个过程中悬挂3L袋生理盐水3米左右高度持续保持压力。采用建立近端前内侧入路的方法建立前内侧入路、前外侧入路、外侧垂直入路、前上外侧入路、近端前外侧入路、中外侧入路、后正中入路和后外侧入路,在此入路上探索新的入路;(5)观察测量:通过不断屈曲肘关节在30°和70°关节镜下观察到有效(视野佳、入镜容易、镜子操作灵活)时测量其肘关节屈曲最适角度,助手保持肘关节屈曲位置,用320°测量角度器(精确到l°)测量其数据并记录影像学资料。采用SPSS19.0统计软件进行数据分析,数据采用均数±标准差(х±s)表示。结果:近端前内侧入路、前内侧入路、前外侧入路、外侧垂直入路在70°关节镜下分别屈曲肘关节(82.90±2.38)°、(84.80±5.41)°、(84.90±2.47)°、(81.20±3.46)°时观察该入路对侧的肘关节腔内解剖结构是视野佳、入镜容易、镜子操作灵活的入路;近端前外侧入路、前上外侧入路在30°关节镜下分别屈曲肘关节(82.90±4.46)°、(79.40±2.46)°时观察该入路对侧的肘关节腔内解剖结构是视野佳、入镜容易、镜子操作灵活的入路;中外侧入路、后正中入路、后外侧入路在70°关节镜下分别屈曲肘关节(71.00±5.14)°、(61.10±3.70)°、(64.30±2.67)°时观察该入路对侧的肘关节腔内解剖结构是视野佳、入镜容易、镜子操作灵活的入路;特殊入路:经后正中入路到鹰嘴窝,再使用磨钻在鹰嘴窝建立一个大小约5~6mm的骨道,关节镜经骨道进入冠突窝。70°关节镜下可见肘关节腔内的前关节囊、部分桡骨小头、冠突、肱骨滑车、大部分肱桡关节面。30°关节镜可见肘关节腔内前关节囊、部分桡骨小头、冠突、肱骨滑车。结论:(1)近端前内侧入路在肘关节屈曲(82.90±2.38)°时应用70°关节镜观察肘关节腔内是有效的内侧入路,推荐作为肘关节镜手术的第一个入镜点。(2)近端前外侧入路在肘关节屈曲(82.90±4.46)°时应用30°关节镜观察肘关节腔内是有效的外侧入路。(3)肘关节镜单一入路均不能全面观察整个肘关节腔,需建立多个联合入路,如:后正中入路,近端前外侧入路,中外侧入路,近端前内侧入路。(4)特殊入路:经后正中入路到鹰嘴窝,再使用磨钻将鹰嘴窝打通进入冠突窝;该入路安全有效,可用于尺神经移位者或部分入路受限者。(5)总体来说应用70°关节镜可更多探查有效的肘关节腔内解剖,但要适当旋转屈曲全方位探索,可减少镜下盲区便于了解腔内解剖结构。
[Abstract]:Objective: through the analysis of 30 degrees and 70 degrees of elbow arthroscopy arthroscopic anatomical view of different approach under the microscope, choose effective (the good view into the mirror, mirror easy, flexible operation) the optimum angle of elbow flexion, provide the anatomical basis for elbow arthroscopy in clinical application. Methods: (1) the thawing of frozen cadaveric elbows; (2) mark and fixed position: carefully touch surface anatomic landmark, lateral axis, and mark the upper arm and forearm of olecranon and medial epicondyle of humerus, lateral epicondylitis of the elbow position, the specimens were thawed is fixed on the bracket with prone position; (3) the establishment of approach: the required measurement approach by vernier caliper measurement and accurate marker of elbow arthroscopy (4); channel establishment: the lateral approach of elbow joint cavity injection of 20ml water expansion. The first one was cut into the skin in the proximal medial approach point About 3~4mm incision, separation of subcutaneous soft tissue and straight hemostatic forceps, and lumbar puncture to the center of the elbow puncture, water outflow pulled out after puncture puncture to the center of the elbow for lumbar puncture, finally with sheath puncture into the cavity and left elbow cone joint cavity, keep the puncture pull out the cone sheath after stabilization, the water flows out after 4.0mm were inserted into the 30 degrees and 70 degrees in the whole process of arthroscopy; saline suspension 3L bag about 3 meters high sustained pressure. Established by method of proximal anteromedial approach established through the anteromedial, anterolateral lateral approach, anterior lateral approach, proximal anterolateral lateral approach, posterior approach and posterolateral approach, then into the road to explore the new approach; (5) observation: through continuous buckling of elbow joint in 30 degrees and 70 degrees under arthroscopy to observe effective (the good view. Easily into the mirror, 闀滃瓙鎿嶄綔鐏垫椿)鏃舵祴閲忓叾鑲樺叧鑺傚眻鏇叉渶閫傝�掑海�

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