Brooks-Hill Alexandra L, Regan William D
Department of Athletic Injuries and Arthroscopy, Sea to Sky Orthopaedics, Squamish General Hospital, Squamish, British Columbia, Canada.
Arthroscopy. 2008 Apr;24(4):483-5. doi: 10.1016/j.arthro.2007.07.015.
We describe a unique extra-articular approach for arthroscopic lateral release for lateral epicondylitis. An arthroscopic extra-articular approach allows better direct visualization of diseased structures with a 30 degrees arthroscope and only requires a small hole in the joint capsule. The camera is placed into the joint through the middle anterolateral portal. The camera is then pulled back through a small rent in the capsule over the lateral radiocapitellar joint to provide an extra-articular view of the diseased structures. The shaver is then placed 1.5 cm proximal to the camera in a proximal anterolateral portal. Debridement of the common extensor fiber tendinosis and decortication of the lateral epicondyle are performed under direct visualization. This is different from the intra-articular technique, where visualization with the 30 degrees arthroscope is more difficult despite a large capsulotomy to aid visualization. The advantage of this extra-articular technique is 2-fold. First, the extra-articular viewing portal allows direct visualization of diseased structures, improving accuracy for debridement compared with an intra-articular viewing portal. The intra-articular technique uses the 30 degrees arthroscope to work around a corner after a large capsulectomy. The second advantage of the extra-articular viewing portal is that it only requires a small capsulotomy. The small capsulotomy decreases the risk of transient radial nerve palsy associated with a capsulectomy. The small capsulotomy also results in less fluid extravasation into the soft tissues. Less fluid extravasation decreases swelling and the risk of compartment syndrome.
我们描述了一种用于关节镜下外侧松解治疗外侧上髁炎的独特关节外入路方法。关节镜下关节外入路使用30度关节镜能更好地直接观察病变结构，且仅需在关节囊上开一个小孔。摄像头通过前外侧中间入路置入关节。然后将摄像头通过桡侧小头关节上方关节囊的一个小裂口拉回，以提供病变结构的关节外视野。接着将刨削器通过近端前外侧入路置于摄像头近端1.5厘米处。在直视下对伸肌总腱腱病进行清创，并对外侧上髁进行皮质剥脱。这与关节内技术不同，在关节内技术中，尽管进行了大的关节囊切开术以辅助观察，但使用30度关节镜观察仍较为困难。这种关节外技术的优势有两方面。首先，关节外观察入路能直接观察病变结构，与关节内观察入路相比，清创准确性更高。关节内技术在大的关节囊切除术后使用30度关节镜从一个角度进行操作。关节外观察入路的第二个优势是仅需进行小的关节囊切开术。小的关节囊切开术降低了与关节囊切除术相关的短暂性桡神经麻痹的风险。小的关节囊切开术还可减少液体渗入软组织。较少的液体渗出可减轻肿胀和骨筋膜室综合征的风险。
