Department of Orthopedics, University of Iowa Hospitals and Clinics, Iowa City, Iowa, USA.
Arthroscopy. 2011 Feb;27(2):228-34. doi: 10.1016/j.arthro.2010.07.017. Epub 2010 Oct 27.
The purpose of this study was to examine the safety and access talonavicular arthroscopy provides for the purpose of arthrodesis through dorsomedial and dorsolateral portals in a cadaveric model.
The talonavicular joints of 8 cadaveric specimens were arthroscopically debrided, by use of a dorsomedial instrumentation portal and a dorsolateral visualization portal. The specimens were dissected with the arthroscopic equipment left in place, the distances from the edge of the instrument to the neurovascular structures were measured, and the specimens were then examined for signs of damage. Finally, the naviculars and tali were removed, and the percentage of debrided subchondral bone was determined by use of ImageJ software (National Institutes of Health, Bethesda, MD).
Examination of the talonavicular joint showed mean subchondral debridement of 98.6% of the navicular and 83.2% of the talus. The dorsomedial portal had a median distance of 4.5 mm, 10.5 mm, and 7 mm to the superficial peroneal nerve, the medial terminal branch of the deep peroneal nerve, and the dorsalis pedis, respectively. The dorsolateral portal had a median distance of 1 mm to the lateral branch of the deep peroneal nerve, with the nerve found resting on the arthroscope in 2 specimens.
Arthroscopic debridement of the talonavicular joint is possible. Because of the risk of damage to the lateral terminal branch of the deep peroneal nerve, an alternative to the dorsolateral portal should be considered.
This study provides evidence that arthroscopic assisted talonavicular arthrodesis is possible but that further research is needed to ensure the safety of the technique.
本研究旨在通过跗跖关节背内侧和背外侧入路，在尸体模型中检查跗跖关节关节镜检查的安全性和可及性，以达到关节融合的目的。
使用背内侧器械入路和背外侧可视化入路，对 8 个尸体标本的跗跖关节进行关节镜下清创。在保留关节镜设备的情况下对标本进行解剖，测量器械边缘到神经血管结构的距离，然后检查标本有无损伤迹象。最后，取出舟骨和距骨，使用 ImageJ 软件（美国国立卫生研究院，贝塞斯达，MD）确定去软骨下骨的百分比。
对跗跖关节的检查显示，舟骨和距骨的软骨下清创分别为 98.6%和 83.2%。背内侧入路距浅腓总神经、深腓总神经内侧终支和足背动脉的中位数分别为 4.5mm、10.5mm 和 7mm。背外侧入路距深腓总神经外侧支的中位数为 1mm，其中 2 例标本中神经位于关节镜下。
跗跖关节的关节镜下清创是可行的。由于深腓总神经外侧终支损伤的风险，应考虑替代背外侧入路。
本研究提供了证据，表明关节镜辅助跗跖关节融合是可行的，但需要进一步研究以确保该技术的安全性。
