腕关节镜掌侧和背侧联合入路的临床应用及效果

目的 介绍一种腕关节镜掌侧入路建立的新方法,报道使用掌侧和背侧联合入路对腕部疾患诊断和治疗的体会.方法 采用"由内向外的交换棒技术"和"由外向内的浅切开深分离"相结合技术建立腕关节镜掌侧入路.自2004年起,通过掌侧和背侧联合入路,进行11例腕部疾患的腕关节镜手术;三角纤维软骨复合体损伤3例(根据Palmer分型,2A型2例,2C型1例),桡骨远端骨折合并韧带损伤5例(根据AO分型,B1型2例,C3型3例),痛风性关节炎3例.男5例,女6例;年龄30～82岁,平均52岁.对所有病例进行随访观察,了解手术的并发症和治疗效果.结果 通过掌侧入路,成功地观察到腕关节的背侧结构,诊断损伤,并能在镜下施行清理和骨折复位手术.所有病例腕关节活动度得以恢复,疼痛有明显缓解,术后腕关节患者自行评估量表(patient-rated wrist evaluation,PRWE)评分为28.6±9.3.术后3～6个月随访显示无手术相关并发症.结论 通过新技术进行腕关节镜掌侧和背侧联合入路手术,安全可行,是腕部疾患诊疗的一种有效方法.

Wrist disorders treated with arthroscopy through volar and dorsal portals: a clinical study

Objective To describe a new technique to establish volar wrist arthroscopic portal and report the clinical results of wrist disorders treated with arthroscopy through the combined dorsal and volar portals.Methods Volar wrist arthroscopic portals were established with the inside-out switching stick and outside-in sweeping forceps technique.Since 2004,11 cases with wrist disorders have been treated under the arthroscopy through volar and dorsal portals.There were three cases of triangular fibrocartilage complex in-juries,5 cases of distal radius fractures and 3 cases of gout wrist arthritis.There were 5 males and 6 females,with a mean age of 52 years(range,30 to 82).All cases were followed up from 3 to 10 months postoperative-ly.Results The volar portals was especially useful for visualizing dorsal capsular structures,debridement and arthroscopy-guided treatment of articular fractures of the distal radius.All cases had got satisfactory functional recovery and the pain alleviated significantly after operation.Postoperative scores finished by the patient-rated wrist evaluation(PRWE)system were 28.6±9.3.No complications occurred.Conclusion Volar portals established by our technique are safe and reliable.Wrist arthroscopy with volar portals is much effective to diagnose and treat wrist disorders.