Slutsky David J
Arthroscopy. 2002 Jul-Aug;18(6):624-30. doi: 10.1053/jars.2002.34106.
To quantitatively describe the neurovascular relationships of a volar radial wrist arthroscopy portal and to evaluate whether volar wrist arthroscopy identified additional pathology of the dorsal capsular structures and the palmar region of the scapholunate interosseous ligament that was not seen through the dorsal portals.
This study was an anatomic study and retrospective chart review.
Cadaver dissections established the neurovascular anatomy of the volar radial portal. Measurements were taken from the portal to the radial artery and its superficial palmar branch; the superficial radial nerve, the median nerve, and its palmar cutaneous branch; and the pronator quadratus. A dorsal capsulotomy was performed to assess the ligamentous interval. A chart review of 30 patients in whom a volar radial portal was used was performed. Intraoperative pathology identified through volar wrist arthroscopy that was not visible through a dorsal portal was recorded. Postoperative neurovascular complications were noted.
There was a greater than 3 mm safe zone surrounding the portal that was free of any neurovascular structures. There were no complications from the use of the portal. Additional pathology that was not visible from a dorsal portal was identified in 10 cases. This included 1 case of hypertrophic synovitis of the dorsal capsule, 1 patient with an avulsion of the radioscapholunate ligament, 1 patient with a tear restricted to the palmar region of the scapholunate interosseous ligament, and 7 patients with tears of the dorsal radiocarpal ligament.
This study provides a safe, standardized approach to the volar radial aspects of the radiocarpal and midcarpal joints. Volar wrist arthroscopy identified additional pathology of the palmar scapholunate interosseous ligament and dorsal capsular structures in 30% of the patients. The volar radial portal should be considered for inclusion in the arthroscopic examination of any patient with radial-sided wrist pain.
定量描述桡侧腕掌关节镜入路的神经血管关系，并评估腕掌关节镜检查是否能发现经背侧入路未观察到的背侧关节囊结构及舟月骨间韧带掌侧区域的其他病变。
本研究为解剖学研究及回顾性病历分析。
通过尸体解剖确定桡侧掌侧入路的神经血管解剖结构。测量从该入路到桡动脉及其掌浅支、桡神经浅支、正中神经及其掌皮支以及旋前方肌的距离。进行背侧关节囊切开术以评估韧带间隙。对30例使用桡侧掌侧入路的患者进行病历回顾。记录通过腕掌关节镜发现但经背侧入路不可见的术中病变情况。记录术后神经血管并发症。
入路周围存在大于3mm的安全区，区内无任何神经血管结构。使用该入路未出现并发症。10例患者发现了经背侧入路不可见的其他病变。其中包括1例背侧关节囊肥厚性滑膜炎、1例桡舟月韧带撕脱患者、1例仅舟月骨间韧带掌侧区域撕裂的患者以及7例背侧桡腕韧带撕裂患者。
本研究为桡腕关节和腕中关节的桡侧掌侧部分提供了一种安全、标准化的入路方法。30%的患者通过腕掌关节镜发现了舟月骨间韧带掌侧及背侧关节囊结构的其他病变。对于任何桡侧腕部疼痛的患者，在关节镜检查时应考虑采用桡侧掌侧入路。
