关节镜下距下关节融合 2 入路外侧入路的安全性和有效性：尸体研究。
Safety and efficiency of a 2-portal lateral approach to arthroscopic subtalar arthrodesis: a cadaveric study.
机构信息
Nouvelle Clinique de l'Union, Saint Jean, France.
出版信息
Arthroscopy. 2013 Jul;29(7):1217-23. doi: 10.1016/j.arthro.2013.04.016.
PURPOSE
To investigate the safety and efficiency of a 2-portal lateral (anterior and middle) approach to arthroscopic subtalar arthrodesis.
METHODS
A cadaveric study was performed on 30 feet of 15 fresh cadaveric bodies (15 right and 15 left; 21 female specimens and 9 male specimens). The mean age at death was 78 ± 6.7 years. The procedure was performed with the specimen in the supine position through 2 lateral (anterior and middle) sinus tarsi portals by use of a 4.0-mm arthroscope. A 3.5-mm synovial shaver was used for debridement, and a 4.5-mm shielded bur was used to resect posterior subtalar facets. The feet were then dissected. The primary outcomes were the percentage of resected joint surface and the distances between portals and both sural and superficial peroneal nerves. The secondary outcomes were injury of sinus tarsi ligaments and lateral arterial network, calcaneofibular ligament, peroneal tendons, flexor hallucis longus tendon, and posterior tibial neurovascular bundle.
RESULTS
The mean percentages of resected talar and calcaneal posterior subtalar facets were 94% ± 7.2% and 91% ± 6.8%, respectively. The minimum distance of either subtalar portal to the nerves was 4 mm. No nerve injury was observed. In 28 of 30 cases, the lateral sinus tarsi arterial network was found intact. In all cases the inferior retinaculum extensor was transfixed by the portals. In all cases both cervical and interosseous talocalcaneal ligaments were found intact. In 3 cases a shaving lesion was observed on the peroneus brevis tendon.
CONCLUSIONS
According to this cadaveric study, more than 90% freshening of the posterior subtalar articular facets can be achieved through a 2-portal lateral (anterior and middle) approach. This technique is reproducible and safe with regard to the surrounding nerves.
CLINICAL RELEVANCE
The 2 lateral portals may offer a safe and effective alternative approach for arthroscopic arthrodesis of the posterior subtalar joint.
目的
研究经 2 个侧方（前中）入路关节镜下距下关节融合术的安全性和有效性。
方法
对 15 具尸体（15 具右侧和 15 具左侧；21 例女性标本和 9 例男性标本）的 30 只脚进行了尸体研究。死亡时的平均年龄为 78 ± 6.7 岁。标本仰卧位，通过 2 个外侧（前中）跗骨窦入路，使用 4.0mm 关节镜进行操作。使用 3.5mm 滑膜刨削器进行清创，使用 4.5mm 屏蔽钻头切除后距下关节面。然后对足部进行解剖。主要结果是切除关节面的百分比和入路与腓肠神经和浅表腓骨外侧神经之间的距离。次要结果是跗骨窦韧带和外侧动脉网、跟腓韧带、腓骨肌腱、屈趾长肌和胫后神经血管束的损伤。
结果
距骨和跟骨后距下关节面的平均切除百分比分别为 94% ± 7.2%和 91% ± 6.8%。两个距下关节入路中任何一个到神经的最小距离均为 4mm。未观察到神经损伤。在 30 例中有 28 例发现外侧跗骨窦动脉网完整。在所有情况下，趾伸肌的下支持带都被入路穿过。在所有情况下，颈和骨间跟距骨间韧带均完整。在 3 例中观察到腓骨短肌腱有刮除损伤。
结论
根据这项尸体研究，通过 2 个侧方（前中）入路可以实现超过 90%的后距下关节面的新鲜化。这种技术是可重复的，并且对周围神经是安全的。
临床相关性
两个外侧入路可能为后距下关节关节镜融合术提供一种安全有效的替代方法。
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