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关节镜下前路关节囊松解治疗退行性肘关节挛缩后桡神经麻痹

Radial nerve palsy after arthroscopic anterior capsular release for degenerative elbow contracture.

作者信息

Park Jin-Young, Cho Chul-Hyun, Choi Jin-Hyung, Lee Sung-Tae, Kang Chul-Hyung

机构信息

Department of Orthopedic Surgery, Kunkok Hospital, Konkuk University, School of Medicine, Seoul, Korea.

出版信息

Arthroscopy. 2007 Dec;23(12):1360.e1-3. doi: 10.1016/j.arthro.2006.11.021. Epub 2007 Mar 13.

Abstract

Because the use of arthroscopy has increased recently for the treatment of elbow lesions, reports of complications have become more common. Nerve injury after arthroscopic anterior capsular release is an extremely rare complication, with 4 reported cases worldwide. We usually use a sharp-tipped electrocautery device with a 0.5-mm diameter during arthroscopic capsular release. In this case, because the former was not prepared, we used a ball-tipped electrocautery device with a 3-mm diameter. Herein, we experienced a case of radial nerve palsy after arthroscopic anterior capsular release using a ball-tipped electrocautery device on a degenerative elbow contracture. We supposed that the electrocautery device caused transiently thermal injury of the radial nerve despite proper portal entry site, intra-articular distension, and gentle arthroscopic manipulation. Elbow arthroscopy remains a technically difficult procedure with the potential for neurologic complications. To perform surgery safely, knowledge of the regional neuroanatomy and a thorough understanding of proper instrument usage are required.

摘要

由于近年来关节镜在肘部病变治疗中的应用增多,并发症的报告也愈发常见。关节镜下前关节囊松解术后的神经损伤是一种极为罕见的并发症,全球仅有4例报告。我们在关节镜下关节囊松解时通常使用直径0.5毫米的尖头电灼装置。在此病例中,因未准备前者,我们使用了直径3毫米的球头电灼装置。在此,我们报告一例在退行性肘关节挛缩患者中使用球头电灼装置进行关节镜下前关节囊松解术后发生桡神经麻痹的病例。我们推测,尽管入口位置合适、关节内扩张良好且关节镜操作轻柔,但电灼装置仍导致了桡神经的短暂热损伤。肘关节镜手术在技术上仍然具有挑战性,存在神经并发症的风险。为了安全地进行手术,需要了解局部神经解剖知识并充分掌握正确的器械使用方法。

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