Witt M, Mittlmeier T
Abt. Unfall- u. Wiederherstellungschirurgie, Universität Rostock, Klinik und Poliklinik für Chirurgie, Schillingallee 35, Rostock, Germany.
Unfallchirurg. 2007 Nov;110(11):953-62; quiz 963. doi: 10.1007/s00113-007-1348-x.
Clear indications have been recognised for arthroscopic surgery of the elbow since the 1980s. Good indications are loose bodies, mild or moderate restriction of the range of movement and early stages of rheumatoid arthritis. Cartilage diseases such as Panner disease or focal radial chondropathy can be treated by arthroscopic debridement and microfracturing. Impingement syndromes affecting the lateral compartment of the joint respond well to resection of synovial plicae. The technical demands of endoscopic arthrolysis procedures for joints with mild or moderate restriction of range of movement are extremely heavy; only experienced surgeons should operate on such patients. Arthroscopy of the elbow joint should be carried out only by operators who have already gained experience in other joints, because of the close relations of nerves and vessels in the elbow. A rigorous standard should be followed in planning the procedure and in creation of the portals and performance of the diagnostic round-up in the joint, to make it possible to work purposefully and quickly, and thus with minimum complications.
自20世纪80年代以来,肘关节镜手术的明确适应证已得到认可。良好的适应证包括关节内游离体、轻度或中度活动范围受限以及类风湿关节炎的早期阶段。诸如潘纳病或局灶性桡骨软骨病等软骨疾病可通过关节镜下清创和微骨折术进行治疗。影响关节外侧间室的撞击综合征对滑膜皱襞切除术反应良好。对于活动范围轻度或中度受限的关节,内镜下关节松解术的技术要求极高;只有经验丰富的外科医生才能为这类患者进行手术。由于肘部神经和血管关系密切,肘关节镜检查应由已在其他关节积累经验的操作人员进行。在规划手术、创建手术入路以及对关节进行诊断性检查时,应遵循严格的标准,以便能够高效且迅速地开展工作,从而将并发症降至最低。