Acevedo J I, Busch M T, Ganey T M, Hutton W C, Ogden J A
Department of Orthopaedics, Atlanta Medical Center, Atlanta, Georgia, USA.
Arthroscopy. 2000 Nov;16(8):836-42. doi: 10.1053/jars.2000.17982.
The authors performed a cadaveric study on 10 ankles and retrospectively reviewed 29 arthroscopic synovectomies to determine the trajectory, minimal safe distances, and complications using a new approach for posterior ankle arthroscopy.
Anatomic study and case series.
A posterolateral portal was established immediately posterior to the peroneal tendon sheath. While staying within the posterior ankle capsule, an inside-out technique was then used to establish the posteromedial portal directly behind the medial malleolus adjacent to the posterior tibial tendon. The cadaveric ankles were frozen, sectioned, and photographed to measure the proximity of neurovascular structures to these coaxial portals. From 1988 to 1994, arthroscopic synovectomy was performed on 23 patients (29 ankles) with hemophilia using these modified portals.
Results of the anatomic study showed that the posterior tibial nerve and posterior tibial artery were located a mean distance of 5.7 mm (SEM, 0.6 mm) and 6.4 mm (SEM, 0.7 mm) from the edge of the cannula, respectively. Neither penetration nor contact of nerve or vessel was observed at either posterior portal. In the 29 clinical cases, posterior capsular synovectomy was achieved arthroscopically with no detectable complications at an average 45-month follow-up.
Our anatomic data show that the coaxial portals described here are essentially equidistant to the neurovascular structures compared with conventional portals. Our clinical results suggest that his technique for posteromedial and posterolateral portals is safe, effective, and reproducible.
作者对10个踝关节进行了尸体研究，并回顾性分析了29例关节镜下滑膜切除术，以确定使用一种新的后踝关节镜检查方法时的手术路径、最小安全距离及并发症情况。
解剖学研究及病例系列。
在腓骨肌腱鞘后方紧邻处建立后外侧入路。在保持位于后踝关节囊内的同时，采用由内向外技术，在内踝后方紧邻胫后肌腱处直接建立后内侧入路。将尸体踝关节冷冻、切片并拍照，以测量神经血管结构与这些同轴入路的接近程度。1988年至1994年期间，对23例（29个踝关节）血友病患者使用这些改良入路进行了关节镜下滑膜切除术。
解剖学研究结果显示，胫后神经和胫后动脉距套管边缘的平均距离分别为5.7毫米（标准误，0.6毫米）和6.4毫米（标准误，0.7毫米）。在后侧两个入路中均未观察到神经或血管的穿透或接触。在29例临床病例中，平均随访45个月时，关节镜下成功完成了后关节囊滑膜切除术，未发现明显并发症。
我们的解剖学数据表明，与传统入路相比，此处描述的同轴入路与神经血管结构的距离基本相等。我们的临床结果表明，这种后内侧和后外侧入路技术安全、有效且可重复。
