肘关节镜"序贯五入路法"的有效性与安全性分析

目的 探讨肘关节镜"序贯五入路法"在肘关节损伤和疾病治疗中的有效性与安全性.方法 2004年4月至2007年5月期间收治53例肘关节镜手术患者,包括肘关节强直24例,骨折15例,肘关节游离体7例,桡骨小头脱位2例,关节结核8例,类风湿关节炎4例,骨化性肌炎5例,色素沉着绒毛结节性滑膜炎3例,滑膜软骨瘤1例.手术入路采用"序贯五入路法",由肘后"软点"建立第一入路后,关节镜监视下于前外侧建立第二入路,通过第二入路绕过冠突由内向外建立第三入路.再在肘后肱三头肌腱两侧建立后外侧人路和后内侧人路,作为第四、五入路.按顺序探查肘关节腔,并进行相应处理.其中3例转为切开手术.术后采取无痛性康复训练,对手术前、后肘关节Mayo功能评分进行比较.结果 46例患者术后获6～34个月(平均11.65个月)随访,Mayo评分:术前45～85分,平均(66.8±11.5)分,良14例,可21例,差11例;术后55～100分,平均(84.5～10.5)分,优16例,良21例,可8例,差1例.术后2例出现一过性神经麻痹症状,其中尺神经深支和桡神经深支各1例,3个月后恢复.结论 采用"序贯五入路法"肘关节镜下显露满意、视野清晰,手术效果好;手术入路安全,并发症少,值得在肘关节镜手术中推广使用.

Efficacy and safety of "Five-Sequential-Portal Method" in elbow arthroscopy

Objective To evaluate the efficacy and safety of "Five-Sequential-Portal Method" which was designed by us in arthroscopy for elbow diseases. Methods From April 2004 to May 2007, 53 patients were treated for elbow diseases with an arthroscopic procedure in our hospital. The final diagnoses included 24 cases of elbow contracture, 15 elbow fracture, 7 loose body, 2 subluxation of capitulum radii, 8 tuberculous arthritis, 4 rheumatoid arthritis, 5 myositis ossificans, 3 pigmented villonodular synovitis and 1 synovial chondromatosis. We used self-designed "Five-Sequential-Portal Method" to establish the portals of elbow arthroscopy. The arthroscopy was inserted into the "soft spot" to make the first portal. The second portal was established anterolaterally under the arthroscopy in the first portal. The third portal was established an-teromedially through the second portal, passing the coronoid process, to make the incision of skin by the in-side-out technique. The forth and the fifth portals were established posterolaterally and postcromcdially on both sides of the triceps tendon. The joint was explored in sequence and an etiotropic procedure was taken. After surgery, rehabilitation exercises were performed under algesia controller. The Mayo elbow-performance indexes before and after surgery were compared. Results In this group, 46 patients were followed up for 6 to 34 (average, 11.65) months. The preoperative Mayo elbow-performance indexes ranged from 45 to 85 (average, 66.8±11.5) points. Fourteen cases were rated as good, 21 fair, and 11 poor. The postoperative Mayo el-bow-performance indexes ranged from 55 to 100 (average, 84.5±10.5) points. Sixteen cases were rated as excellent, 21 good, 8 fair, and 1 poor. Two patients had transient nerve palsy, involving one ulnar nerve and one deep branch of the radial nerve, but recovered in 3 months. Condusions Our "Five-Sequential-Portal Method" can ensure satisfactory exposure and clear view in elbow arthroseopy. The portals are safe, leading to low incidence of postoperative complications. It is recommendable in clinic.