腕关节镜掌侧入路的实验与临床研究

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.

Experimental and clinical study of the volar portals of wrist arthroscopy

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.