Fontès D
Institut main et sport, clinique générale du sport, 36, boulevard Saint-Marcel, 75005 Paris, France.
Chir Main. 2004 Dec;23(6):270-83. doi: 10.1016/j.main.2004.09.009.
Arthroscopy of the wrist is a recent technique but already validated for many indications. It rarely gives rise to complications but requires a learning curve just like any other endoscopic procedure. It allows complete visualization of the osseous, articular, synovial and ligamentous structures of the different joints comprising the wrist. There are two main indications for wrist arthroscopy: i) Diagnostic; when other investigations have proved inconclusive (assessment of carpal instabilities, osteochondral fractures and certain synovial pathologies...); ii) therapeutic; these have recently widened in terms of carpal pathology. Lesions of the triangular fibrocartilage complex (traumatic or degenerative) are best diagnosed and treated arthroscopically. Arthroscopic treatment is the least invasive, most effective and safest means of performing procedures such as debridement, TFCC reattachment, and ulna shortening. Other conditions can benefit greatly from wrist arthroscopy such as certain wrist ganglions, rheumatoid synovitis, radiocarpal fractures and some scaphoid fractures. Degenerative pathology of the wrist also presents opportunities for articular debridement ("shaving"), synovectomy or even various "ectomies".
腕关节镜检查是一项较新的技术,但已在多种适应证中得到验证。它很少引发并发症,但与其他任何内镜手术一样,需要一个学习过程。它能够完整地观察构成腕关节的不同关节的骨质、关节面、滑膜和韧带结构。腕关节镜检查主要有两个适应证:i)诊断性;当其他检查结果不明确时(评估腕骨不稳、骨软骨骨折和某些滑膜病变……);ii)治疗性;就腕骨病变而言,其治疗适应证最近有所扩大。三角纤维软骨复合体损伤(创伤性或退行性)通过关节镜检查能得到最佳诊断和治疗。关节镜治疗是进行清创、三角纤维软骨复合体重新附着和尺骨缩短等手术的侵入性最小、最有效且最安全的方法。其他病症也能从腕关节镜检查中大大受益,如某些腕部腱鞘囊肿、类风湿性滑膜炎、桡腕关节骨折和一些舟骨骨折。腕关节的退行性病变也为关节清创(“刨削”)、滑膜切除术甚至各种“切除术”提供了机会。